Healthcare Provider Details

I. General information

NPI: 1598440778
Provider Name (Legal Business Name): AHMED SOUID MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 GENESEE ST STE 203
AUBURN NY
13021-3498
US

IV. Provider business mailing address

17 LANSING ST
AUBURN NY
13021-1983
US

V. Phone/Fax

Practice location:
  • Phone: 315-255-0947
  • Fax:
Mailing address:
  • Phone: 315-255-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number343244
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: