Provider Demographics
NPI:1861489783
Name:FARUQUI, SHAISTA HODA (MD)
Entity type:Individual
Prefix:
First Name:SHAISTA
Middle Name:HODA
Last Name:FARUQUI
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 1:5320 DIJON DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4395
Mailing Address - Country:US
Mailing Address - Phone:225-769-2161
Mailing Address - Fax:225-769-2166
Practice Address - Street 1:5320 DIJON DRIVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4395
Practice Address - Country:US
Practice Address - Phone:225-769-2161
Practice Address - Fax:225-769-2166
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04632R207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1300004Medicaid
LA1300004Medicaid
LA5L188Medicare UPIN