Provider Demographics
NPI:1104430396
Name:SHERWANI, RIDA
Entity type:Individual
Prefix:
First Name:RIDA
Middle Name:
Last Name:SHERWANI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RIDA
Other - Middle Name:
Other - Last Name:SHERWANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBBS
Mailing Address - Street 1:50 PRESIDENTIAL PLZ APT 205
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-2206
Mailing Address - Country:US
Mailing Address - Phone:631-469-8260
Mailing Address - Fax:
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:631-469-8260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program