=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508074063
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAHIDA BASHIR MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2007
-----------------------------------------------------
Last Update Date | 06/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13455 S MILITARY TRL STE A
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33484-1323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-424-3180
-----------------------------------------------------
Fax | 561-300-2531
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13455 S MILITARY TRL STE A
-----------------------------------------------------
City | DELRAY BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33484-1323
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-424-3180
-----------------------------------------------------
Fax | 561-300-2531
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 22024
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------