Healthcare Provider Details

I. General information

NPI: 1619023223
Provider Name (Legal Business Name): SYED SHAHZAD MUSTAFA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 W RIDGE RD 5TH FLOOR
ROCHESTER NY
14626-2801
US

IV. Provider business mailing address

2300 W RIDGE RD STE 5
ROCHESTER NY
14626-2801
US

V. Phone/Fax

Practice location:
  • Phone: 585-922-8350
  • Fax: 585-922-3315
Mailing address:
  • Phone: 585-922-8350
  • Fax: 585-922-8355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number252196
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: