Provider Demographics
NPI:1407803562
Name:SHAHIDA, SHUBI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHUBI
Middle Name:
Last Name:SHAHIDA
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 1:712 WILKINS ST STE A
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4664
Mailing Address - Country:US
Mailing Address - Phone:919-989-9109
Mailing Address - Fax:919-989-9821
Practice Address - Street 1:712 WILKINS ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4664
Practice Address - Country:US
Practice Address - Phone:919-989-9109
Practice Address - Fax:919-989-9821
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-01514207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902696Medicaid
NCP00356481OtherRAILROAD MEDICARE
NC2049869AMedicare PIN
NC5902696Medicaid