Provider Demographics
NPI:1649098047
Name:SHAH, SYED FAISAL ALI SR
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:FAISAL ALI
Last Name:SHAH
Suffix:SR
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 1:1108 S
Mailing Address - Street 2:THOMAS ST
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-0971
Mailing Address - Country:US
Mailing Address - Phone:540-645-1791
Mailing Address - Fax:
Practice Address - Street 1:1108 S
Practice Address - Street 2:THOMAS ST
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-0971
Practice Address - Country:US
Practice Address - Phone:540-645-1791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA11752388332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies