MEDICARE: DR. SYED SHAHZAD MUSTAFA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	252196	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619023223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SYED SHAHZAD MUSTAFA MD

Provider Business Mailing Address
First Line	:	2300 W RIDGE RD STE 5
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2801
Country	:	US
Telephone Number	:	585-922-8350
Fax Number	:	585-922-8355

Provider Business Practice Location Address
First Line	:	2300 W RIDGE RD
Second Line	:	5TH FLOOR
City	:	ROCHESTER
State	:	NY
Zip	:	14626-2801
Country	:	US
Telephone Number	:	585-922-8350
Fax Number	:	585-922-3315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	03/25/2020

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