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Individual

AYYAZ M SHAH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
200 FRONT ST, VESTAL, NY 13850-1559
(607) 658-1003
(607) 658-1006
Mailing address
33 LEWIS RD, 2ND FL, BINGHAMTON, NY 13905
(607) 770-0025

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
203641
NY
207N00000X
Dermatology Physician
OS10163
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
001992700
FL
Enumeration date
07/26/2007
Last updated
10/27/2020
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