Provider Demographics
NPI:1407494446
Name:SHAHGALDI, BITA
Entity Type:Individual
Prefix:
First Name:BITA
Middle Name:
Last Name:SHAHGALDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-5648
Mailing Address - Country:US
Mailing Address - Phone:904-282-3070
Mailing Address - Fax:
Practice Address - Street 1:2720 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-5648
Practice Address - Country:US
Practice Address - Phone:904-282-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52144183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist