Provider Demographics
NPI:1366586646
Name:SHAMTOUB, SHIVA (DO)
Entity type:Individual
Prefix:DR
First Name:SHIVA
Middle Name:
Last Name:SHAMTOUB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14712 ROCKAWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11436-1634
Mailing Address - Country:US
Mailing Address - Phone:718-732-7744
Mailing Address - Fax:347-644-1745
Practice Address - Street 1:14712 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11436-1634
Practice Address - Country:US
Practice Address - Phone:718-732-7744
Practice Address - Fax:347-644-1745
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY241306207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine