Healthcare Provider Details

I. General information

NPI: 1609337468
Provider Name (Legal Business Name): FAHEEMA SYED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1637 DEER PARK AVE
DEER PARK NY
11729-5202
US

IV. Provider business mailing address

15 SUTTON HILL LN
NEW HYDE PARK NY
11040-1032
US

V. Phone/Fax

Practice location:
  • Phone: 631-887-5566
  • Fax: 631-223-1887
Mailing address:
  • Phone: 516-462-1620
  • Fax: 631-223-1887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number314948
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: