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General NPI Number Information
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NPI Number | 1508015207
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Entity Type | Individual
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Provider Name | FAWAD A. SHAHEEN MD
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Gender | Male
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 335 31ST ST S
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City | ST PETERSBURG
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State | FL
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Zip | 33712-1419
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Country | US
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Telephone | 727-289-7139
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Fax | 727-289-7140
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Provider Business Mailing Address
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Address Line | PO BOX 636256 CENTRAL CREDENTIALING
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City | CINCINNATI
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State | OH
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Zip | 45263-0001
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Country | US
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Telephone | 513-585-5504
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Fax | 513-585-5511
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD2022-1142
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License Number State | NM
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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 | ME111493
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License Number State | FL
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