Healthcare Provider Details

I. General information

NPI: 1235187527
Provider Name (Legal Business Name): SYED NASEERUDDIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 11/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 PROGRESS LN
SAINT CLOUD FL
34769-6519
US

IV. Provider business mailing address

3505 PROGRESS LN
SAINT CLOUD FL
34769-6519
US

V. Phone/Fax

Practice location:
  • Phone: 407-891-8044
  • Fax: 407-891-8016
Mailing address:
  • Phone: 407-891-8044
  • Fax: 407-891-8016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME0085486
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: