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General NPI Number Information
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NPI Number | 1376258517
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Entity Type | Individual
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Provider Name | SHAJEDA BINTE BORHAN
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Gender | Female
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Dates
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Enumeration Date | 01/23/2023
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 1135 S MAIN ST STE B
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City | LAS CRUCES
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State | NM
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Zip | 88005-2946
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Country | US
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Telephone | 575-525-4000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13129
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City | SALEM
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State | OR
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Zip | 97309-1129
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Country | US
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Telephone | 503-391-1110
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD2022-1188
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD219162
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License Number State | OR
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