Healthcare Provider Details

I. General information

NPI: 1205935087
Provider Name (Legal Business Name): SAEEDA A MAHMUD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 HEALTHY WAY
ELLENVILLE NY
12428-5612
US

IV. Provider business mailing address

10 HEALTHY WAY
ELLENVILLE NY
12428-5612
US

V. Phone/Fax

Practice location:
  • Phone: 845-647-2510
  • Fax: 845-647-2975
Mailing address:
  • Phone: 845-647-2510
  • Fax: 845-647-2975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number189663
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: