Healthcare Provider Details

I. General information

NPI: 1215873575
Provider Name (Legal Business Name): YASMEEN HETSCEMA SHABAZZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE
SYRACUSE NY
13203-1807
US

IV. Provider business mailing address

207 LINWOOD AVE
ALBION NY
14411-9761
US

V. Phone/Fax

Practice location:
  • Phone: 315-703-5200
  • Fax: 315-703-5201
Mailing address:
  • Phone: 585-202-9908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: