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General NPI Number Information
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NPI Number | 1871565028
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Entity Type | Individual
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Provider Name | SHAKIL MUSTAFA SYED OD
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 06/06/2011
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Provider Practice Location Address
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Address Line | 4080 HUNTER CT
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City | EASTON
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State | PA
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Zip | 18045
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Country | US
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Telephone | 717-343-4373
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Fax |
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Provider Business Mailing Address
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Address Line | 4080 HUNTER CT
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City | EASTON
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State | PA
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Zip | 18045
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Country | US
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Telephone | 717-505-7914
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Fax | 717-343-4373
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OEG001631
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License Number State | PA
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