Provider Demographics
NPI:1518031848
Name:JAMIL, SHABANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHABANA
Middle Name:
Last Name:JAMIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHABANA
Other - Middle Name:
Other - Last Name:NAAZIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1020 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1748
Mailing Address - Country:US
Mailing Address - Phone:607-754-5342
Mailing Address - Fax:607-754-5508
Practice Address - Street 1:1020 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1748
Practice Address - Country:US
Practice Address - Phone:607-754-5342
Practice Address - Fax:607-754-5508
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02833856Medicaid
NYG58128Medicare UPIN
NY02833856Medicaid