Healthcare Provider Details

I. General information

NPI: 1770136756
Provider Name (Legal Business Name): SYEDA AFZAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 KINGS HIGHWAY PEDIATRICS
SHREVEPORT LA
71130-3932
US

IV. Provider business mailing address

1541 KINGS HIGHWAY PEDIATRICS
SHREVEPORT LA
71130-3932
US

V. Phone/Fax

Practice location:
  • Phone: 318-626-2274
  • Fax:
Mailing address:
  • Phone: 318-626-2274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number345997
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number345997
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: