MEDICARE: FAIZA SHAFIQUE APRN

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	363LG0600X	Gerontology Nurse Practitioner	11016303	FL
2	363LA2200X	Adult Health Nurse Practitioner	11016303	FL

General Provider Information

NPI Number	:	1851051957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAIZA SHAFIQUE APRN

Provider Business Mailing Address
First Line	:	9309 MADEWOOD CT
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-4408
Country	:	US
Telephone Number	:	561-777-2957
Fax Number	:

Provider Business Practice Location Address
First Line	:	9309 MADEWOOD CT
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-4408
Country	:	US
Telephone Number	:	561-777-2957
Fax Number	:

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

Provider Enumeration Date	:	12/30/2021
Last Update Date	:	12/30/2021

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