Healthcare Provider Details

I. General information

NPI: 1063496586
Provider Name (Legal Business Name): ABDUL QUDOOS SHAHID M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 340453
BEAVERCREEK OH
45434-0453
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-8610
  • Fax: 352-273-8612
Mailing address:
  • Phone: 937-280-4970
  • Fax: 937-630-4578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LH0002X
TaxonomyHospice and Palliative Medicine (Anesthesiology) Physician
License Number35.085482
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number21937
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number35.085482
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME165211
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number35.085482
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: