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General NPI Number Information
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NPI Number | 1619097169
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Entity Type | Individual
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Provider Name | OMID M SEYLABI MD
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Gender | Male
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 06/17/2021
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Provider Practice Location Address
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Address Line | 2100 NE 36TH ST SUITE 201
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City | LIGHTHOUSE POINT
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State | FL
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Zip | 33064-7574
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Country | US
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Telephone | 954-781-0180
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Fax |
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Provider Business Mailing Address
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Address Line | 241 LAFAYETTE RD APT 341
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City | SYRACUSE
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State | NY
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Zip | 13205-2931
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Country | US
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Telephone | 315-416-3753
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME98075
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License Number State | FL
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