Healthcare Provider Details

I. General information

NPI: 1386247591
Provider Name (Legal Business Name): DR. SHAN SYED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2020
Last Update Date: 08/24/2024
Certification Date: 08/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11588 ALLISONVILLE RD
FISHERS IN
46038-1846
US

IV. Provider business mailing address

11001 PARKLAND CT
FISHERS IN
46037-4198
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-7773
  • Fax:
Mailing address:
  • Phone: 330-787-7617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number03135534
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number26030583A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: