Provider Demographics
NPI:1588678718
Name:RASOOL, SHAMA (MD)
Entity Type:Individual
Prefix:
First Name:SHAMA
Middle Name:
Last Name:RASOOL
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 1:7603 113TH STREET
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6585
Mailing Address - Country:US
Mailing Address - Phone:718-268-1100
Mailing Address - Fax:718-263-6418
Practice Address - Street 1:7603 113TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-6585
Practice Address - Country:US
Practice Address - Phone:718-268-1100
Practice Address - Fax:718-263-6418
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1594182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00929204Medicaid
NY00929204Medicaid
NYE42028Medicare UPIN