Provider Demographics
NPI:1770705204
Name:RUMMAN, SYEDA SHAISTA (MD)
Entity type:Individual
Prefix:
First Name:SYEDA
Middle Name:SHAISTA
Last Name:RUMMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 VETERANS AVE BLDG 3
Mailing Address - Street 2:ROOM 126D
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2410
Mailing Address - Country:US
Mailing Address - Phone:228-523-5470
Mailing Address - Fax:228-523-4971
Practice Address - Street 1:400 VETERANS AVE BLDG 3
Practice Address - Street 2:ROOM 126D
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2410
Practice Address - Country:US
Practice Address - Phone:228-523-5470
Practice Address - Fax:228-523-4971
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.29973207R00000X, 207RC0000X
MS24298207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02832263Medicaid