Provider Demographics
NPI:1023427580
Name:ABBAS, SYEDA A
Entity type:Individual
Prefix:
First Name:SYEDA
Middle Name:A
Last Name:ABBAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 58TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-2216
Mailing Address - Country:US
Mailing Address - Phone:718-536-9721
Mailing Address - Fax:
Practice Address - Street 1:3335 58TH ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-2216
Practice Address - Country:US
Practice Address - Phone:718-536-9721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-10
Last Update Date:2014-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYUT14851QMedicaid