Healthcare Provider Details

I. General information

NPI: 1437072329
Provider Name (Legal Business Name): MUHAMMAD ISHAQ SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 IRVING AVE STE 300
SYRACUSE NY
13210-1603
US

IV. Provider business mailing address

6 PRESIDENTIAL CTS # 13202
SYRACUSE NY
13202-2222
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-9630
  • Fax:
Mailing address:
  • Phone: 315-403-4149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: