Healthcare Provider Details

I. General information

NPI: 1326245614
Provider Name (Legal Business Name): MUNIRA SHABBIR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 JONATHAN LUCAS ST CLINICAL SCIENCE BUILDING, SUITE # 903
CHARLESTON SC
29425-8900
US

IV. Provider business mailing address

810 HIDEAWAY BAY LN APT # K
MT PLEASANT SC
29464-2955
US

V. Phone/Fax

Practice location:
  • Phone: 843-792-4271
  • Fax:
Mailing address:
  • Phone: 312-545-9080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLL 29707
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: