Healthcare Provider Details

I. General information

NPI: 1508887514
Provider Name (Legal Business Name): RANA SHAFIQ-HODA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE ROOM 2-2142B
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE P.O.BOX 626
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-1602
  • Fax: 585-276-4027
Mailing address:
  • Phone: 585-275-1602
  • Fax: 585-276-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number21548
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number196073
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: