Provider Demographics
NPI:1629049036
Name:AMANULLAH, SHAKEEL (MD)
Entity Type:Individual
Prefix:
First Name:SHAKEEL
Middle Name:
Last Name:AMANULLAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 N DUKE ST
Mailing Address - Street 2:SUITE 244
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2374
Mailing Address - Country:US
Mailing Address - Phone:717-544-7679
Mailing Address - Fax:717-544-4964
Practice Address - Street 1:540 N DUKE ST
Practice Address - Street 2:SUITE 244
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2374
Practice Address - Country:US
Practice Address - Phone:717-544-4930
Practice Address - Fax:717-544-4964
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422116174400000X
IN01064290A207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101294097Medicaid
IN000000531300OtherANTHEM PROVIDER NUMBER
IN200872750Medicaid
IN200872750Medicaid
IN224390EEMedicare PIN
PA090839GFJMedicare PIN
IN815490CCCCMedicare PIN
INP00414714Medicare PIN
IN815500I4Medicare PIN
IN815450IIMedicare PIN
IN000000531300OtherANTHEM PROVIDER NUMBER