MEDICARE: SYED SHAFEEQ UR RAHMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	ME86628	FL

General Provider Information

NPI Number	:	1518028679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYED SHAFEEQ UR RAHMAN M.D.

Provider Business Mailing Address
First Line	:	805 VIRGINIA AVE
Second Line	:	SUITE 16
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5881
Country	:	US
Telephone Number	:	772-468-6969
Fax Number	:	772-465-5160

Provider Business Practice Location Address
First Line	:	805 VIRGINIA AVE
Second Line	:	SUITE 16
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-5881
Country	:	US
Telephone Number	:	772-468-6969
Fax Number	:	772-465-5160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	12/02/2024

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