Healthcare Provider Details

I. General information

NPI: 1285657650
Provider Name (Legal Business Name): SHAGUFTA H SHAIKH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 LINDENWOOD DR
EXTON PA
19341-2147
US

IV. Provider business mailing address

45 LINDENWOOD DR
EXTON PA
19341-2147
US

V. Phone/Fax

Practice location:
  • Phone: 570-332-4292
  • Fax:
Mailing address:
  • Phone: 570-332-4292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD437561
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1285657650
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerNPI
# 2
IdentifierMD437561
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA STATE LICENSE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: