Provider Demographics
NPI:1356483028
Name:MD SHAHED ARZU MD PA
Entity Type:Organization
Organization Name:MD SHAHED ARZU MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHED
Authorized Official - Middle Name:
Authorized Official - Last Name:ARZU
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:704-778-3697
Mailing Address - Street 1:10173 BOCA VISTA DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-1589
Mailing Address - Country:US
Mailing Address - Phone:954-495-6408
Mailing Address - Fax:
Practice Address - Street 1:7737 N UNIVERSITY DR
Practice Address - Street 2:SUITE 104
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2961
Practice Address - Country:US
Practice Address - Phone:954-720-6902
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92910170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX ID
FLAD173ZMedicare PIN