Basic Information
| Provider Information | |||||||||
| NPI: | 1659329803 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NOUKLA | ||||||||
| FirstName: | SHAHERA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1185 SWEET HOME RD | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142261018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166890040 | ||||||||
| FaxNumber: | 7165682330 | ||||||||
| Practice Location | |||||||||
| Address1: | 1185 SWEET HOME RD | ||||||||
| Address2: | |||||||||
| City: | AMHERST | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142261018 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166890040 | ||||||||
| FaxNumber: | 7165682330 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2006 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 226625-1 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000527123001 | 01 | NY | HEALTH NOW | OTHER | 161000580 | 01 | NY | NOVA | OTHER | 161000580 | 01 | NY | AETNA | OTHER | 161000580 | 01 | NY | EMPIRE | OTHER | 02375024 | 05 | NY | MEDICAID | 00026166301 | 01 | NY | UNIVERA | OTHER | 0411557 | 01 | NY | IHA | OTHER | 161000580 | 01 | NY | NORTH AMERICAN PREFERRED | OTHER |