Provider Demographics
NPI:1851651442
Name:SHAD, YASAR (MD)
Entity Type:Individual
Prefix:
First Name:YASAR
Middle Name:
Last Name:SHAD
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 1:60 KNOCHE WAY
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2420
Mailing Address - Country:US
Mailing Address - Phone:856-981-3426
Mailing Address - Fax:
Practice Address - Street 1:3041 ORCHARD PARK RD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1238
Practice Address - Country:US
Practice Address - Phone:856-355-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY295819207RC0200X
NY295819-1207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology