Basic Information
| Provider Information | |||||||||
| NPI: | 1528215092 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOIZUDDIN | ||||||||
| FirstName: | SHAHIDA | ||||||||
| MiddleName: | P | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1545 9TH ST SW | ||||||||
| Address2: | |||||||||
| City: | VERO BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329624312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722578224 | ||||||||
| FaxNumber: | 7722133157 | ||||||||
| Practice Location | |||||||||
| Address1: | 13505 US HIGHWAY 1 | ||||||||
| Address2: | |||||||||
| City: | SEBASTIAN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 329583759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7722578224 | ||||||||
| FaxNumber: | 7722133157 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2008 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | ME49096 | FL | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | ME49096 | 01 | FL | FL LICENSE | OTHER |