Healthcare Provider Details

I. General information

NPI: 1073405304
Provider Name (Legal Business Name): SHAZIA BASHIR MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2025
Last Update Date: 07/21/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 OSCEOLA ELEMENTARY RD STE A
ST AUGUSTINE FL
32084-5942
US

IV. Provider business mailing address

707 1ST ST S APT 604
JACKSONVILLE BEACH FL
32250-6670
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAZIA BASHIR
Title or Position: OWNER AND CEO
Credential: MD, MPH
Phone: 314-479-9243