Provider Demographics
NPI:1275254831
Name:SHAHZAD, MOHSIN
Entity Type:Individual
Prefix:
First Name:MOHSIN
Middle Name:
Last Name:SHAHZAD
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 1:166 WINNIKEE AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-2755
Mailing Address - Country:US
Mailing Address - Phone:347-256-0663
Mailing Address - Fax:845-204-9887
Practice Address - Street 1:166 WINNIKEE AVE APT 3
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-2755
Practice Address - Country:US
Practice Address - Phone:347-256-0663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY812049081172A00000X
NY421399170172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver