Syed Jibran Shah, D.O

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

289028 Issued in NY

Practice address

1780 Hanshaw Rd
Ithaca, NY 14850-9105

Phone

(607) 257-5858

Fax

(607) 257-1718

NPI assigned

Mar 31, 2014

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1518385269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ONE GUTHRIE SQUARE",
            "city": "SAYRE",
            "state": "PA",
            "postal_code": "188401625",
            "telephone_number": "570-888-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1780 HANSHAW RD",
            "city": "ITHACA",
            "state": "NY",
            "postal_code": "148509105",
            "telephone_number": "607-257-5858",
            "fax_number": "607-257-1718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SYED",
        "middle_name": "JIBRAN",
        "credential": "D.O",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-03-31",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "289028",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lois J Sessions, COTA
• Louise Anne Seyge, REGISTERED NURSE
• SH Ithaca Operator, Inc. (Brookdale Ithaca Assisted Living)
• Jill Shah, PT, DPT
• Sapan Shah, M.D.
• Mohammad Ali Shahab, MBBS
• Aidan Lee Shahamad, PA-S
• Hamid Saeed Shaikh
• Shakespeare & Muscente LCSW, PLLC (Life Stages Counseling)
• Leslie Shakespeare, LCSW

• Family Medicine Physician in Ithaca, NY
• Providers in Ithaca, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.