Healthcare Provider Details

I. General information

NPI: 1659991073
Provider Name (Legal Business Name): SHEHZAD AHMED M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date: 01/10/2022
Reactivation Date: 01/24/2022

III. Provider practice location address

750 E. ADAMS STREET
SYRACUSE NY
13210
US

IV. Provider business mailing address

750 E. ADAMS STREET
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5420
  • Fax:
Mailing address:
  • Phone: 315-464-5420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number324613
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: