Individual
DR. PAYAM SHAKOURI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2585 SOUTH RD, SUITE 15A, POUGHKEEPSIE, NY 12601-7000
(845) 454-1399
(845) 397-1333
Mailing address
425 ROBINSON AVE, SUITE 1, NEWBURGH, NY 12550-3363
(845) 561-6196
(845) 561-2221
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
273010
NY
207RN0300X
Nephrology Physician
Primary
273010
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04154798
—
NY
01
—
A400121944
MEDICARE PTAN
NY
Enumeration date
02/01/2013
Last updated
05/08/2017
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