Provider Demographics
NPI:1346416021
Name:RASHIDZADA, WAHID (MD)
Entity type:Individual
Prefix:DR
First Name:WAHID
Middle Name:
Last Name:RASHIDZADA
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 1:595 ROUTE 25A STE 2
Mailing Address - Street 2:
Mailing Address - City:MILLER PLACE
Mailing Address - State:NY
Mailing Address - Zip Code:11764-2648
Mailing Address - Country:US
Mailing Address - Phone:631-238-8271
Mailing Address - Fax:631-532-1908
Practice Address - Street 1:595 ROUTE 25A STE 2
Practice Address - Street 2:
Practice Address - City:MILLER PLACE
Practice Address - State:NY
Practice Address - Zip Code:11764
Practice Address - Country:US
Practice Address - Phone:631-238-8271
Practice Address - Fax:631-532-1908
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273165-12084S0012X
KS04335362084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200613180AMedicaid
MO1346416021Medicaid
KS139000023Medicare PIN