Healthcare Provider Details

I. General information

NPI: 1245211887
Provider Name (Legal Business Name): SYED A JAFRI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 17TH ST
SAINT CLOUD FL
34769-6006
US

IV. Provider business mailing address

2906 17TH ST
SAINT CLOUD FL
34769-6006
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7856
  • Fax:
Mailing address:
  • Phone: 321-841-7856
  • Fax: 321-843-6432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME79297
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberME79297
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME79297
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: