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General NPI Number Information
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NPI Number | 1821233305
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Entity Type | Organization
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Legal Business Name | SYED SHAFEEQ UR RAHMAN PA
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Dates
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Enumeration Date | 12/11/2008
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 805 VIRGINIA AVE SUITE 16
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City | FORT PIERCE
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State | FL
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Zip | 34982-5881
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Country | US
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Telephone | 772-468-6969
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Fax | 772-465-5160
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Provider Business Mailing Address
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Address Line | 805 VIRGINIA AVE SUITE 16
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City | FORT PIERCE
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State | FL
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Zip | 34982-5881
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Country | US
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Telephone | 772-468-6969
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Fax | 772-465-5160
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Authorized Official
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Title or Position | M.D.
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Name | SYED SHAFEEQ UR RAHMAN
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Credential | M.D.
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Telephone | 772-468-6969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME86628
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License Number State | FL
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