Provider Demographics
NPI:1821034695
Name:SHAH, SYED ASIF (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:ASIF
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4099
Mailing Address - Country:US
Mailing Address - Phone:315-785-4000
Mailing Address - Fax:315-779-6610
Practice Address - Street 1:830 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4099
Practice Address - Country:US
Practice Address - Phone:315-785-4000
Practice Address - Fax:315-779-6610
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2025-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU6577207RC0000X
NY220900207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000526457003OtherBC/BS OF WESTERN NY
TX1821034695Medicaid
NYP020220900OtherBLUE SHIELD
NY2111257OtherINDEPENDENT HEALTH
NY7522255OtherAETNA
NY00025582604OtherUNIVERA
NY02158703Medicaid
NYP010220900OtherBLUE CHOICE
NYG60443Medicare UPIN