Provider Demographics
NPI:1508074063
Name:BASHIR, SHAHIDA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHIDA
Middle Name:
Last Name:BASHIR
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 1:13455 S MILITARY TRL STE A
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-1323
Mailing Address - Country:US
Mailing Address - Phone:561-424-3180
Mailing Address - Fax:561-300-2531
Practice Address - Street 1:13455 S MILITARY TRL STE A
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-1323
Practice Address - Country:US
Practice Address - Phone:561-424-3180
Practice Address - Fax:561-300-2531
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22024174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist