Provider Demographics
NPI:1891192092
Name:ROSHAN SHAD, ESTHER (MS, PA-C)
Entity Type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:ROSHAN SHAD
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-2517
Mailing Address - Country:US
Mailing Address - Phone:718-942-3888
Mailing Address - Fax:
Practice Address - Street 1:5601 1ST AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2517
Practice Address - Country:US
Practice Address - Phone:718-942-3888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018102363A00000X
NY164119363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant