Healthcare Provider Details

I. General information

NPI: 1124019260
Provider Name (Legal Business Name): SHABANA PARVEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHABANA VALI

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2831 OAK GLEN CT
GRAND PRAIRIE TX
75052-0401
US

IV. Provider business mailing address

2831 OAK GLEN CT
GRAND PRAIRIE TX
75052-0401
US

V. Phone/Fax

Practice location:
  • Phone: 682-256-2749
  • Fax: 833-295-9082
Mailing address:
  • Phone: 682-256-2749
  • Fax: 833-295-9082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM7506
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberM7506
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: