MEDICARE: DR. ZOHRA SHAD 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	207SG0201X	Clinical Genetics (M.D.) Physician	35099265	OH
2	207SG0201X	Clinical Genetics (M.D.) Physician	036133413	IL
3	208000000X	Pediatrics Physician	S0084	TX
4	207SG0201X	Clinical Genetics (M.D.) Physician	S0084	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962602904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZOHRA SHAD MD

Provider Business Mailing Address
First Line	:	PO BOX 733784
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75373-3784
Country	:	US
Telephone Number	:	682-885-1860
Fax Number	:	682-885-1396

Provider Business Practice Location Address
First Line	:	2459 E HEBRON PKWY STE 100
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75010-4477
Country	:	US
Telephone Number	:	972-757-0345
Fax Number	:	972-767-0335

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

Provider Enumeration Date	:	07/18/2007
Last Update Date	:	09/27/2021

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