Healthcare Provider Details

I. General information

NPI: 1821106303
Provider Name (Legal Business Name): SHAZIA SIDDIQI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 02/04/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 MAIN ST STE 1
OLEAN NY
14760-1500
US

IV. Provider business mailing address

535 MAIN ST STE 1
OLEAN NY
14760-1500
US

V. Phone/Fax

Practice location:
  • Phone: 167-372-0141
  • Fax: 163-736-6327
Mailing address:
  • Phone: 167-372-0141
  • Fax: 163-736-6327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number240075
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: