Provider Demographics
NPI:1558557868
Name:SHAKIRA HUSAIN MD PA
Entity Type:Organization
Organization Name:SHAKIRA HUSAIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-217-3545
Mailing Address - Street 1:100 WHETSTONE PL
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5774
Mailing Address - Country:US
Mailing Address - Phone:904-296-1160
Mailing Address - Fax:904-483-5852
Practice Address - Street 1:100 WHETSTONE PL
Practice Address - Street 2:STE 206
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5774
Practice Address - Country:US
Practice Address - Phone:904-217-3545
Practice Address - Fax:904-562-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003341600Medicaid
FLDE3583OtherRAILROAD MEDICARE
FLDE3583OtherRAILROAD MEDICARE