Provider Demographics
NPI:1386893139
Name:SYED, SAIRA S (DO)
Entity type:Individual
Prefix:
First Name:SAIRA
Middle Name:S
Last Name:SYED
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SAIRA
Other - Middle Name:
Other - Last Name:MIRZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1729 BURRSTONE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-1001
Mailing Address - Country:US
Mailing Address - Phone:315-798-1702
Mailing Address - Fax:315-798-1726
Practice Address - Street 1:1729 BURRSTONE RD
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1001
Practice Address - Country:US
Practice Address - Phone:315-798-1702
Practice Address - Fax:315-798-1726
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY266778207R00000X
2518390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORDO126285OtherLICENSE
NY03547399Medicaid