=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386709822
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | INAYATHULLAH SYED PA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1190 NW 95TH ST SUITE302
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33150-2063
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-835-0312
-----------------------------------------------------
Fax | 305-691-9224
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1190 N W 95 STREET SUITE 302
-----------------------------------------------------
City | MIANI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33150
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-835-0312
-----------------------------------------------------
Fax | 305-691-9224
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA9100125
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------