Provider Demographics
NPI:1366519597
Name:SHUKRI-MAHMOD, HASSAN S (MD)
Entity type:Individual
Prefix:
First Name:HASSAN
Middle Name:S
Last Name:SHUKRI-MAHMOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 BRITTONFIELD PARKWAY
Mailing Address - Street 2:SUITE A116
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-634-5550
Mailing Address - Fax:315-634-5553
Practice Address - Street 1:5000 BRITTONFIELD PARKWAY
Practice Address - Street 2:SUITE A116
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-634-5550
Practice Address - Fax:315-634-5553
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY195245174400000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRA9178Medicare PIN
NYE33825Medicare UPIN