Provider Demographics
NPI:1356447619
Name:SHUJAUDDIN, FAHEEM (MD)
Entity Type:Individual
Prefix:
First Name:FAHEEM
Middle Name:
Last Name:SHUJAUDDIN
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 1:12121 RICHMOND AVE
Mailing Address - Street 2:SUITE # 204
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-2432
Mailing Address - Country:US
Mailing Address - Phone:281-531-8013
Mailing Address - Fax:281-531-7237
Practice Address - Street 1:12121 RICHMOND AVE
Practice Address - Street 2:SUITE # 204
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2432
Practice Address - Country:US
Practice Address - Phone:281-531-8013
Practice Address - Fax:281-531-7237
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH7508174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122856105Medicaid
TXE38571OtherUPIN #
TX122856105Medicaid