MEDICARE: SHAHROZ DAUD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	0401417163	VA

General Provider Information

NPI Number	:	1407469539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHROZ DAUD

Provider Business Mailing Address
First Line	:	5621 TIDEWATER DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-1497
Country	:	US
Telephone Number	:	757-622-3776
Fax Number	:

Provider Business Practice Location Address
First Line	:	5621 TIDEWATER DR
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23509-1497
Country	:	US
Telephone Number	:	757-622-3776
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	08/28/2020

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Directions to “ SHAHROZ DAUD ” Practice Location

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