Provider Demographics
NPI:1902457112
Name:HUSSAINI, SYEDA SAFURA
Entity Type:Individual
Prefix:
First Name:SYEDA
Middle Name:SAFURA
Last Name:HUSSAINI
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 1:337 HAROLD ST
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4146
Mailing Address - Country:US
Mailing Address - Phone:347-469-6675
Mailing Address - Fax:
Practice Address - Street 1:337 HAROLD ST
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4146
Practice Address - Country:US
Practice Address - Phone:347-469-6675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-28
Last Update Date:2019-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009063152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist