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General NPI Number Information
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NPI Number | 1356429625
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Entity Type | Individual
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Provider Name | SHAZIA MUKADDAM MD
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Gender | Female
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 03/10/2022
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Provider Practice Location Address
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Address Line | 5100 COCONUT CREEK PKWY
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City | MARGATE
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State | FL
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Zip | 33063-3913
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Country | US
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Telephone | 954-281-7700
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Fax | 954-715-7603
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Provider Business Mailing Address
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Address Line | 1395 NW 167TH ST
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City | MIAMI GARDENS
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State | FL
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Zip | 33169-5710
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Country | US
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Telephone | 954-281-7700
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Fax | 954-715-7603
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 25MA08136600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME129980
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License Number State | FL
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