Provider Demographics
NPI:1518028679
Name:RAHMAN, SYED SHAFEEQ UR (MD)
Entity Type:Individual
Prefix:
First Name:SYED SHAFEEQ
Middle Name:UR
Last Name:RAHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:805 VIRGINIA AVE
Mailing Address - Street 2:SUITE 16
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-5881
Mailing Address - Country:US
Mailing Address - Phone:772-468-6969
Mailing Address - Fax:772-465-5160
Practice Address - Street 1:805 VIRGINIA AVE
Practice Address - Street 2:SUITE 16
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5881
Practice Address - Country:US
Practice Address - Phone:772-468-6969
Practice Address - Fax:772-465-5160
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME86628208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH87159Medicare UPIN