Provider Demographics
NPI:1558776450
Name:ALAM, SHAFAYET (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHAFAYET
Middle Name:
Last Name:ALAM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SUNY DOWNSTATE PODIATRY DEPT
Mailing Address - Street 2:450 CLARKSON AVENUE
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2012
Mailing Address - Country:US
Mailing Address - Phone:972-207-0368
Mailing Address - Fax:
Practice Address - Street 1:SUNY DOWNSTATE PODIATRY DEPT
Practice Address - Street 2:450 CLARKSON AVENUE
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2012
Practice Address - Country:US
Practice Address - Phone:718-270-1537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-30
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR399213ES0103X
NYP121104390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPR399OtherFLORIDA BOARD OF HEATH