Healthcare Provider Details

I. General information

NPI: 1689303497
Provider Name (Legal Business Name): SHAZIA FAROOQUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2302 SAM RAYBURN HWY STE 100
MELISSA TX
75454-2696
US

IV. Provider business mailing address

2302 SAM RAYBURN HWY STE 100
MELISSA TX
75454-2696
US

V. Phone/Fax

Practice location:
  • Phone: 469-907-4840
  • Fax:
Mailing address:
  • Phone: 469-907-4840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number37958
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: