Provider Demographics
NPI:1861500837
Name:HTAY-SHA, PAMELA THAN (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:THAN
Last Name:HTAY-SHA
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 1:136-20 38TH AVE, 4-CFB
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354
Mailing Address - Country:US
Mailing Address - Phone:718-358-8889
Mailing Address - Fax:718-358-8890
Practice Address - Street 1:136-20 38TH AVE, 4-CFB
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354
Practice Address - Country:US
Practice Address - Phone:718-358-8889
Practice Address - Fax:718-358-8890
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02526176Medicaid
NY200AL1Medicare ID - Type UnspecifiedEMPIRE
NYI03096Medicare UPIN