Provider Demographics
NPI:1801263074
Name:ZAIDI-KHAN, SYEDA MAVRA (OD)
Entity type:Individual
Prefix:MRS
First Name:SYEDA
Middle Name:MAVRA
Last Name:ZAIDI-KHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3133 69TH ST
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1227
Mailing Address - Country:US
Mailing Address - Phone:917-485-0382
Mailing Address - Fax:
Practice Address - Street 1:2519 35TH ST
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11103-4870
Practice Address - Country:US
Practice Address - Phone:718-728-3606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008344-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist