Provider Demographics
NPI:1891152765
Name:HUSSAIN, MOHAMMAD SHAMSHAD (RSA, MBBS)
Entity type:Individual
Prefix:DR
First Name:MOHAMMAD
Middle Name:SHAMSHAD
Last Name:HUSSAIN
Suffix:
Gender:M
Credentials:RSA, MBBS
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Other - First Name:
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Mailing Address - Street 1:2684 WEST ST
Mailing Address - Street 2:APT 4D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-6455
Mailing Address - Country:US
Mailing Address - Phone:504-473-5097
Mailing Address - Fax:
Practice Address - Street 1:2684 WEST ST
Practice Address - Street 2:APT 4D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-6455
Practice Address - Country:US
Practice Address - Phone:504-473-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-24
Last Update Date:2016-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYU000210363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical