Provider Demographics
NPI:1821034695
Name:SHAH, SYED ASIF (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:ASIF
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4211 JOE RAMSEY BLVD E STE 105
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75401-7858
Mailing Address - Country:US
Mailing Address - Phone:469-518-9765
Mailing Address - Fax:844-290-4367
Practice Address - Street 1:4211 JOE RAMSEY BLVD E STE 105
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7858
Practice Address - Country:US
Practice Address - Phone:469-518-9765
Practice Address - Fax:844-290-4367
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY220900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000526457003OtherBC/BS OF WESTERN NY
NY2111257OtherINDEPENDENT HEALTH
NY00025582604OtherUNIVERA
NYP010220900OtherBLUE CHOICE
NY02158703Medicaid
NYP020220900OtherBLUE SHIELD
NY7522255OtherAETNA
NYP010220900OtherBLUE CHOICE
NYG60443Medicare UPIN