Provider Demographics
NPI:1619023223
Name:MUSTAFA, SYED SHAHZAD (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:SHAHZAD
Last Name:MUSTAFA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 W RIDGE RD STE 5
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-2801
Mailing Address - Country:US
Mailing Address - Phone:585-922-8350
Mailing Address - Fax:585-922-8355
Practice Address - Street 1:2300 W RIDGE RD
Practice Address - Street 2:5TH FLOOR
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-2801
Practice Address - Country:US
Practice Address - Phone:585-922-8350
Practice Address - Fax:585-922-3315
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252196207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03118994Medicaid
NYJ400005656Medicare PIN