Provider Demographics
NPI:1205607769
Name:SYED, SHAIRIN (OD)
Entity type:Individual
Prefix:DR
First Name:SHAIRIN
Middle Name:
Last Name:SYED
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6406 EMERALD GREEN CT
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-3825
Mailing Address - Country:US
Mailing Address - Phone:571-201-0534
Mailing Address - Fax:
Practice Address - Street 1:2316 MEETINGHOUSE RD
Practice Address - Street 2:
Practice Address - City:UPPER CHICHESTER
Practice Address - State:PA
Practice Address - Zip Code:19061-3438
Practice Address - Country:US
Practice Address - Phone:610-485-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-12
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG004232152W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No152W00000XEye and Vision Services ProvidersOptometrist