Provider Demographics
NPI:1205849411
Name:FIRDOUS, SHABANA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHABANA
Middle Name:
Last Name:FIRDOUS
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 1:1812 PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6365
Mailing Address - Country:US
Mailing Address - Phone:540-667-1226
Mailing Address - Fax:540-667-0519
Practice Address - Street 1:1812 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6365
Practice Address - Country:US
Practice Address - Phone:540-667-1226
Practice Address - Fax:540-667-0519
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012325622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010164257Medicaid
153450OtherANTHEM
H78811Medicare UPIN
VA010164257Medicaid