Healthcare Provider Details

I. General information

NPI: 1043839707
Provider Name (Legal Business Name): MISHAL SHAUKAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 E. ADAMS ST. 5TH FLOOR
SYRACUSE NY
13210
US

IV. Provider business mailing address

DEPT. OF MEDICINE MEDICAL SERVICES GROUP 725 E. ADAMS ST., 5TH FLOOR
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5726
  • Fax: 315-464-2510
Mailing address:
  • Phone: 315-464-5726
  • Fax: 315-464-2510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number341092
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: