MEDICARE: DR. SHABANA QURESHI 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	207Q00000X	Family Medicine Physician	0101243323	VA

General Provider Information

NPI Number	:	1982885760
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHABANA QURESHI MD

Provider Business Mailing Address
First Line	:	5441 MAPLEDALE PLZ
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-4526
Country	:	US
Telephone Number	:	571-659-9387
Fax Number	:

Provider Business Practice Location Address
First Line	:	5441 MAPLEDALE PLZ
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-4526
Country	:	US
Telephone Number	:	571-659-9387
Fax Number	:

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

Provider Enumeration Date	:	11/20/2007
Last Update Date	:	01/23/2023

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