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General NPI Number Information
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NPI Number | 1073017174
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Entity Type | Individual
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Provider Name | NISREEN SHABBIR EZUDDIN MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 12/17/2025
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Provider Practice Location Address
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Address Line | 160 NW 170TH ST
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33169-5521
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Country | US
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Telephone | 305-651-1100
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Fax |
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Provider Business Mailing Address
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Address Line | 4581 WESTON RD
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City | WESTON
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State | FL
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Zip | 33331-3141
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Country | US
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Telephone | 305-654-5221
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Fax | 305-654-6872
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 2025039391
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 0451790
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License Number State | KS
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 0451790
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License Number State | KS
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Taxonomy #5
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2025039391
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License Number State | MO
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Taxonomy #6
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | ME146753
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License Number State | FL
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