Provider Demographics
NPI:1063597680
Name:SHAHABUDDIN, SYED X (RPH)
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:
Last Name:SHAHABUDDIN
Suffix:X
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 BELL AIR LN
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4414
Mailing Address - Country:US
Mailing Address - Phone:845-297-1394
Mailing Address - Fax:
Practice Address - Street 1:1895 SOUTH RD
Practice Address - Street 2:
Practice Address - City:POK
Practice Address - State:NY
Practice Address - Zip Code:12601
Practice Address - Country:US
Practice Address - Phone:845-298-0097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY031042183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist