Active NPI
Shady Aly Ismail Elattar
- Pharmacist
- Gray, ME
National Provider Identifier
1356574941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PR5603
- Practice address
- 62 W Gray Rd
Gray, ME 04039-9772 - Phone
- (207) 657-2333
- NPI assigned
- Aug 28, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | PR5603 | ME | Primary |
Addresses
Primary practice location
62 W Gray Rd
Gray, ME 04039-9772
Mailing address
15 Ledges CT
Lewiston, ME 04240-1851
Phone (207) 423-9986
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PR5603 | ME | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1251417600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1251417600000",
"number": "1356574941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15 LEDGES CT",
"city": "LEWISTON",
"state": "ME",
"postal_code": "042401851",
"telephone_number": "207-423-9986"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "62 W GRAY RD",
"city": "GRAY",
"state": "ME",
"postal_code": "040399772",
"telephone_number": "207-657-2333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELATTAR",
"first_name": "SHADY",
"middle_name": "ALY ISMAIL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-08-28",
"last_updated": "2009-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "ME",
"license": "PR5603",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gray, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.