Healthcare Provider Details

I. General information

NPI: 1750886990
Provider Name (Legal Business Name): DR. SHAHEEN MIZYED
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NE 13TH ST
OKLAHOMA CITY OK
73104-5004
US

IV. Provider business mailing address

2900 N MILITARY TRL STE 200
BOCA RATON FL
33431-6308
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-6651
  • Fax:
Mailing address:
  • Phone: 561-955-2570
  • Fax: 561-955-2572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME149929
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number46942
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: