Basic Information
| Provider Information | |||||||||
| NPI: | 1568702496 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUFYAN | ||||||||
| FirstName: | BASHEER | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3925 NW 43RD ST | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326064565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177069777 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3925 NW 43RD ST | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326064565 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3523711777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2013 | ||||||||
| LastUpdateDate: | 12/09/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 5601006608 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 5508 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.