Provider Demographics
NPI:1790594968
Name:BUKHARI, JEHANZEB (PA)
Entity type:Individual
Prefix:
First Name:JEHANZEB
Middle Name:
Last Name:BUKHARI
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 KELSEY DR
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-1254
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5586 LEGIONNAIRE DR STE 1
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:NY
Practice Address - Zip Code:13039-3504
Practice Address - Country:US
Practice Address - Phone:315-699-2837
Practice Address - Fax:315-752-0030
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-02
Last Update Date:2025-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034612363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty