Provider Demographics
NPI:1376532580
Name:RANDHAWA, SHAHID RASUL (MD)
Entity Type:Individual
Prefix:
First Name:SHAHID
Middle Name:RASUL
Last Name:RANDHAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5333 N DIXIE HWY
Mailing Address - Street 2:STE 109
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3453
Mailing Address - Country:US
Mailing Address - Phone:954-717-1919
Mailing Address - Fax:954-717-2528
Practice Address - Street 1:2510 E OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1601
Practice Address - Country:US
Practice Address - Phone:954-717-1919
Practice Address - Fax:954-717-2528
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92264207KA0200X, 207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL16010OtherBCBS
FL003737500Medicaid
FL16010YMedicare PIN
FL16010OtherBCBS