Provider Demographics
NPI:1194210260
Name:RAZZAQ, SHAZIA
Entity Type:Individual
Prefix:
First Name:SHAZIA
Middle Name:
Last Name:RAZZAQ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 DEL MAR DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-2704
Mailing Address - Country:US
Mailing Address - Phone:571-215-9433
Mailing Address - Fax:
Practice Address - Street 1:3910 DEL MAR DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-2704
Practice Address - Country:US
Practice Address - Phone:571-215-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor