Provider Demographics
NPI:1093448219
Name:SYED, SHUJA SHAWN
Entity Type:Individual
Prefix:
First Name:SHUJA
Middle Name:SHAWN
Last Name:SYED
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31878 DEL OBISPO ST # 118-124
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-3223
Mailing Address - Country:US
Mailing Address - Phone:949-667-5773
Mailing Address - Fax:
Practice Address - Street 1:2238 SPECTRUM
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3136
Practice Address - Country:US
Practice Address - Phone:949-667-5773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-05
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic