Healthcare Provider Details

I. General information

NPI: 1588127849
Provider Name (Legal Business Name): SHABAAZ SANDHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2019
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12321 W LINEBAUGH AVE
WESTCHASE FL
33626-2651
US

IV. Provider business mailing address

12321 W LINEBAUGH AVE
WESTCHASE FL
33626-2651
US

V. Phone/Fax

Practice location:
  • Phone: 813-531-8515
  • Fax: 813-587-9004
Mailing address:
  • Phone: 813-531-8515
  • Fax: 813-587-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number169407
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: