Healthcare Provider Details

I. General information

NPI: 1972171080
Provider Name (Legal Business Name): SHAHIDA BINTI MIZAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2021
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 W PRATT ST FL 4
BALTIMORE MD
21201-1023
US

IV. Provider business mailing address

701 W PRATT ST FL 4
BALTIMORE MD
21201-1023
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-5881
  • Fax:
Mailing address:
  • Phone: 410-328-5881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0102954
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberD0102954
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: