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General NPI Number Information
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NPI Number | 1871832790
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Entity Type | Individual
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Provider Name | SHUJA UDDIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/13/2013
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Last Update Date | 03/07/2022
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Provider Practice Location Address
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Address Line | 750 E ADAMS ST
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City | SYRACUSE
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State | NY
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Zip | 13210-2342
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Country | US
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Telephone | 315-944-5557
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Fax |
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Provider Business Mailing Address
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Address Line | 3231 EUCLID AVE STE 407
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City | BERWYN
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State | IL
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Zip | 60402-3472
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Country | US
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Telephone | 708-783-7430
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036131334
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 262817
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License Number State | NY
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