Provider Demographics
NPI:1386629673
Name:BEGUM, SHAMSAD (MD)
Entity Type:Individual
Prefix:
First Name:SHAMSAD
Middle Name:
Last Name:BEGUM
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 1:1195 N MILITARY TRL
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6058
Mailing Address - Country:US
Mailing Address - Phone:561-683-4100
Mailing Address - Fax:561-683-4755
Practice Address - Street 1:1195 N MILITARY TRL
Practice Address - Street 2:SUITE 2A
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6058
Practice Address - Country:US
Practice Address - Phone:561-683-4100
Practice Address - Fax:561-683-4755
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME7377870207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006570100OtherGRP MEDICAID ID
FLDN212AOtherMEDICARE GRP PTAN
FL257951100Medicaid
FL1770716623OtherGROUP NPI
FL650975960OtherTAX ID
FL650975960OtherTAX ID
FL257951100Medicaid
FL650975960OtherTAX ID