Healthcare Provider Details

I. General information

NPI: 1083636450
Provider Name (Legal Business Name): SHAZAH KHAWAJA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SONOMA AVE STE 18
SANTA ROSA CA
95404-4804
US

IV. Provider business mailing address

900 SONOMA AVE STE 18
SANTA ROSA CA
95404-4804
US

V. Phone/Fax

Practice location:
  • Phone: 707-579-1102
  • Fax: 707-579-1386
Mailing address:
  • Phone: 707-579-1102
  • Fax: 707-579-1386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number239820
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number048447
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number25MA08177000
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC55816
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: