Provider Demographics
NPI:1578839775
Name:KASHIF, SHUMAILA (MD)
Entity Type:Individual
Prefix:
First Name:SHUMAILA
Middle Name:
Last Name:KASHIF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 YELLOWSTONE DR
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-4305
Mailing Address - Country:US
Mailing Address - Phone:732-983-2924
Mailing Address - Fax:
Practice Address - Street 1:66 W GILBERT ST STE 100
Practice Address - Street 2:
Practice Address - City:TINTON FALLS
Practice Address - State:NJ
Practice Address - Zip Code:07701-4948
Practice Address - Country:US
Practice Address - Phone:732-212-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09733700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1578839775Medicaid