Provider Demographics
NPI:1982849659
Name:SHAMSI, SYED ALI RAZA (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:ALI RAZA
Last Name:SHAMSI
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3818 TEACHERS LN
Mailing Address - Street 2:APT 12
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-2132
Mailing Address - Country:US
Mailing Address - Phone:646-345-1747
Mailing Address - Fax:
Practice Address - Street 1:305 E. FAIRMONT AVENUE
Practice Address - Street 2:UNIT 7
Practice Address - City:LAKEWOOD
Practice Address - State:NY
Practice Address - Zip Code:14750
Practice Address - Country:US
Practice Address - Phone:716-526-4041
Practice Address - Fax:716-526-4161
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-10
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY267162-12084P0015X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine