MEDICARE: SHAZIA BASHIR M.D,

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207VX0201X	Gynecologic Oncology Physician	ME120013	FL
2	207VX0201X	Gynecologic Oncology Physician	1017343	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073788634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAZIA BASHIR M.D,

Provider Business Mailing Address
First Line	:	707 1ST ST S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-6652
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 1ST ST S
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32250-6652
Country	:	US
Telephone Number	:	314-479-9243
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2008
Last Update Date	:	05/20/2025

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Directions to “ SHAZIA BASHIR M.D,” Practice Location

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