Provider Demographics
NPI:1588750970
Name:HUSSAIN, SYED S (MD)
Entity type:Individual
Prefix:DR
First Name:SYED
Middle Name:S
Last Name:HUSSAIN
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 1:7628 103RD ST
Mailing Address - Street 2:STE 7
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-9735
Mailing Address - Country:US
Mailing Address - Phone:904-771-1116
Mailing Address - Fax:
Practice Address - Street 1:7685 103RD ST 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-9326
Practice Address - Country:US
Practice Address - Phone:904-771-1116
Practice Address - Fax:904-394-5115
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74307207Q00000X, 208VP0014X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL42510Medicare ID - Type UnspecifiedMC