Provider Demographics
NPI:1669201307
Name:RAZI, SYED SHOAIB
Entity type:Individual
Prefix:
First Name:SYED
Middle Name:SHOAIB
Last Name:RAZI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:CAVE SPRING
Mailing Address - State:VA
Mailing Address - Zip Code:24018-4149
Mailing Address - Country:US
Mailing Address - Phone:917-251-3967
Mailing Address - Fax:
Practice Address - Street 1:4907 BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:CAVE SPRING
Practice Address - State:VA
Practice Address - Zip Code:24018-4149
Practice Address - Country:US
Practice Address - Phone:540-774-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2025-08-21
Deactivation Date:2025-05-13
Deactivation Code:
Reactivation Date:2025-08-14
Provider Licenses
StateLicense IDTaxonomies
VA04014196221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice