Provider Demographics
NPI:1386964682
Name:ZEIDAN, SUHAD
Entity type:Individual
Prefix:
First Name:SUHAD
Middle Name:
Last Name:ZEIDAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 N COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-3445
Mailing Address - Country:US
Mailing Address - Phone:516-561-2619
Mailing Address - Fax:
Practice Address - Street 1:291 N COTTAGE ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-3445
Practice Address - Country:US
Practice Address - Phone:516-561-2619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053296183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist