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General NPI Number Information
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NPI Number | 1679198857
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Entity Type | Individual
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Provider Name | SYED FAZAL SHAH PMHNP
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Gender | Male
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 03/01/2022
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Provider Practice Location Address
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Address Line | 1967 WEHRLE DR
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City | BUFFALO
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State | NY
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Zip | 14221-8452
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Country | US
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Telephone | 415-278-7037
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Fax |
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Provider Business Mailing Address
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Address Line | 719 HARRISON ST RM 126
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City | SYRACUSE
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State | NY
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Zip | 13210-2305
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Country | US
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Telephone | 315-256-0055
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 403108
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License Number State | NY
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