Healthcare Provider Details

I. General information

NPI: 1255398707
Provider Name (Legal Business Name): HAJIRA M SHUJAAT O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HAJIRA MOINUDDIN O.D.

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 01/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 WEST COLONIAL DR. SUITE 183
OCOEE FL
34761-3434
US

IV. Provider business mailing address

160 BOSTON AVE
ALTAMONTE SPRINGS FL
32701-4798
US

V. Phone/Fax

Practice location:
  • Phone: 407-834-7776
  • Fax: 407-834-0973
Mailing address:
  • Phone: 407-834-7776
  • Fax: 407-834-0973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 4096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: