Provider Demographics
NPI:1669205696
Name:SHAH, SHAZIA QAISAR (MD)
Entity type:Individual
Prefix:
First Name:SHAZIA
Middle Name:QAISAR
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 WHISPERFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:MURPHY
Mailing Address - State:TX
Mailing Address - Zip Code:75094
Mailing Address - Country:US
Mailing Address - Phone:214-449-2286
Mailing Address - Fax:
Practice Address - Street 1:1002 OSWEGO ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5031
Practice Address - Country:US
Practice Address - Phone:315-798-8868
Practice Address - Fax:315-733-7105
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP130258207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine