Healthcare Provider Details

I. General information

NPI: 1730708033
Provider Name (Legal Business Name): MARIAM SHABBIR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date: 01/10/2022
Reactivation Date: 01/27/2022

III. Provider practice location address

2024 15TH ST FL 2
MERIDIAN MS
39301-4130
US

IV. Provider business mailing address

350 N HUMPHREYS BLVD
MEMPHIS TN
38120-2177
US

V. Phone/Fax

Practice location:
  • Phone: 601-553-2000
  • Fax: 601-553-6856
Mailing address:
  • Phone: 901-226-4003
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number36943
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2025001461
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: