MEDICARE: SHAHID M NASIR MD

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	2085R0202X	Diagnostic Radiology Physician	MD17542	ME
2	2085R0202X	Diagnostic Radiology Physician	ME93304	FL

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	:	1811904238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHID M NASIR MD

Provider Business Mailing Address
First Line	:	130 CORRIDOR RD UNIT 428
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32004-7718
Country	:	US
Telephone Number	:	907-551-0703
Fax Number	:	904-551-0709

Provider Business Practice Location Address
First Line	:	1052 PONTE VEDRA BLVD
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-4015
Country	:	US
Telephone Number	:	904-551-0703
Fax Number	:	904-551-0709

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	10/07/2021

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