Provider Demographics
NPI:1952566655
Name:SANDHU, SHIRAZ (DO)
Entity Type:Individual
Prefix:DR
First Name:SHIRAZ
Middle Name:
Last Name:SANDHU
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 RUIN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5932
Mailing Address - Country:US
Mailing Address - Phone:252-436-1352
Mailing Address - Fax:
Practice Address - Street 1:894 EASTERN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-3618
Practice Address - Country:US
Practice Address - Phone:718-774-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY246230207R00000X
NC2016-01510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine