Healthcare Provider Details

I. General information

NPI: 1073788634
Provider Name (Legal Business Name): SHAZIA BASHIR M.D,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 1ST ST S
JACKSONVILLE FL
32250-6652
US

IV. Provider business mailing address

707 1ST ST S
JACKSONVILLE FL
32250-6652
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-9243
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME120013
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number1017343
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: