Healthcare Provider Details

I. General information

NPI: 1851375067
Provider Name (Legal Business Name): SHMAILA ISHAQ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 11/02/2021
Certification Date: 11/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6405 N FEDERAL HWY SUITE 300
FORT LAUDERDALE FL
33308-1412
US

IV. Provider business mailing address

11511 SHADOW CREEK PKWY
PEARLAND TX
77584-7298
US

V. Phone/Fax

Practice location:
  • Phone: 954-958-5220
  • Fax: 954-528-5218
Mailing address:
  • Phone: 713-442-4997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS0302
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberS0302
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME 107147
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: