MEDICARE: DR. SHAHIDA DADABHOY 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	2080A0000X	Pediatric Adolescent Medicine Physician	A51315	CA

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669472163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAHIDA DADABHOY M.D

Provider Business Mailing Address
First Line	:	145 W WILLOW ST
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91768-1829
Country	:	US
Telephone Number	:	909-865-5555
Fax Number	:	909-865-5565

Provider Business Practice Location Address
First Line	:	145 W WILLOW ST
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91768-1829
Country	:	US
Telephone Number	:	909-865-5555
Fax Number	:	909-865-5565

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

Provider Enumeration Date	:	07/26/2005
Last Update Date	:	11/14/2025

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