MEDICARE: AYESHA SHABBIR MAHMOUD MD

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	208000000X	Pediatrics Physician	MD39033	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538185459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AYESHA SHABBIR MAHMOUD MD

Provider Business Mailing Address
First Line	:	5 MARINE VIEW PLZ
Second Line	:
City	:	HOBOKEN
State	:	NJ
Zip	:	07030-5756
Country	:	US
Telephone Number	:	201-798-1333
Fax Number	:	201-798-5333

Provider Business Practice Location Address
First Line	:	10 EXCHANGE PL
Second Line	:	15TH FLOOR
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3918
Country	:	US
Telephone Number	:	201-821-8911
Fax Number	:	201-603-6688

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

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	01/30/2014

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