Provider Demographics
NPI:1528215092
Name:MOIZUDDIN, SHAHIDA P (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHIDA
Middle Name:P
Last Name:MOIZUDDIN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1555 INDIAN RIVER BLVD STE B210
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-7113
Mailing Address - Country:US
Mailing Address - Phone:772-257-8224
Mailing Address - Fax:772-252-3245
Practice Address - Street 1:13505 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3759
Practice Address - Country:US
Practice Address - Phone:772-257-8224
Practice Address - Fax:772-252-3245
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2025-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME49096208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME49096OtherFL LICENSE