Individual
SHAUN SHAZAM ALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10120 LIBERTY AVE, OZONE PARK, NY 11417-1702
(718) 480-6875
(718) 480-1267
Mailing address
10120 LIBERTY AVE, OZONE PARK, NY 11417-1702
(718) 480-6875
(718) 480-1267
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
B03211
NY
Other
Enumeration date
07/10/2019
Last updated
07/10/2019
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