Healthcare Provider Details

I. General information

NPI: 1649949447
Provider Name (Legal Business Name): SHAHZAIB MIRZA MD MEDICAL PARTNERS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19910 S TAMIAMI TRL STE C
ESTERO FL
33928-4140
US

IV. Provider business mailing address

2104 W FIRST ST APT 2704
FORT MYERS FL
33901-3274
US

V. Phone/Fax

Practice location:
  • Phone: 929-228-9657
  • Fax:
Mailing address:
  • Phone: 929-228-9657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAHZAIB MIRZA
Title or Position: CEO/MD
Credential: MD
Phone: 929-228-9657