Provider Demographics
NPI:1043957970
Name:EZALDIN, SHADY AHMED HASSANIEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHADY
Middle Name:AHMED HASSANIEN
Last Name:EZALDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 MACCORKLE AVENUE SOUTHEAST
Mailing Address - Street 2:ROBERT C. BIRD CLINICAL TEACHING CENTER, 4TH FLOOR
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304
Mailing Address - Country:US
Mailing Address - Phone:304-388-5590
Mailing Address - Fax:304-388-8238
Practice Address - Street 1:3200 MACCORKLE AVENUE SOUTHEAST
Practice Address - Street 2:ROBERT C. BIRD CLINICAL TEACHING CENTER, 4TH FLOOR
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304
Practice Address - Country:US
Practice Address - Phone:304-388-5590
Practice Address - Fax:304-388-8238
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program