Provider Demographics
NPI:1225206253
Name:HYDER, SHAZIA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAZIA
Middle Name:
Last Name:HYDER
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 1:1652 PLUM LN
Mailing Address - Street 2:STE 103
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4594
Mailing Address - Country:US
Mailing Address - Phone:909-239-9824
Mailing Address - Fax:
Practice Address - Street 1:1652 PLUM LN
Practice Address - Street 2:STE 103
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4594
Practice Address - Country:US
Practice Address - Phone:909-239-9824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-12
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA106954207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program