Provider Demographics
NPI:1811512361
Name:FAZAL, SHAMY BUSHRA (DPM)
Entity type:Individual
Prefix:DR
First Name:SHAMY
Middle Name:BUSHRA
Last Name:FAZAL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 86TH ST STE 402
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-3023
Mailing Address - Country:US
Mailing Address - Phone:212-628-4444
Mailing Address - Fax:
Practice Address - Street 1:210 E 86TH ST RM 402
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-7726
Practice Address - Country:US
Practice Address - Phone:212-628-4444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY071069-00213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine