Provider Demographics
NPI:1669673398
Name:ANJUM, SHEHRYAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHEHRYAR
Middle Name:
Last Name:ANJUM
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 1:17 LANSING ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-255-7576
Mailing Address - Fax:315-702-8393
Practice Address - Street 1:77 NELSON ST
Practice Address - Street 2:SUITE 240
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1944
Practice Address - Country:US
Practice Address - Phone:315-567-0390
Practice Address - Fax:315-702-8393
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL28253207R00000X
PAMD447427207R00000X
NY319016207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY319016OtherPHYSICIAN LICENSE
AL51542516OtherBLUE CROSS BLUE SHIELD
AL51115220OtherBLUE CROSS
AL631500073Medicaid
AL51115220OtherBLUE CROSS