Provider Demographics
NPI:1366641565
Name:SULEMAN, SHAHIDA ISHAQ (PT)
Entity Type:Individual
Prefix:MRS
First Name:SHAHIDA
Middle Name:ISHAQ
Last Name:SULEMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 N BEND RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-3113
Mailing Address - Country:US
Mailing Address - Phone:410-409-8559
Mailing Address - Fax:410-630-5561
Practice Address - Street 1:5623 REISTERSTOWN RD STE 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-3451
Practice Address - Country:US
Practice Address - Phone:410-949-2919
Practice Address - Fax:410-630-5561
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18993225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDRTD61478804OtherBC/BS
MD149MG433Medicare PIN