Healthcare Provider Details

I. General information

NPI: 1821063108
Provider Name (Legal Business Name): SHAKAIB S QURESHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 LANCASTER PIKE SUITE 9
WILMINGTON DE
19805-1436
US

IV. Provider business mailing address

PO BOX 30170
WILMINGTON DE
19805-7170
US

V. Phone/Fax

Practice location:
  • Phone: 302-830-5297
  • Fax: 302-656-5270
Mailing address:
  • Phone: 302-830-5297
  • Fax: 302-623-4395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberC10007826
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: