Provider Demographics
NPI:1588632533
Name:FATTEH, SHAHNAZ (MD)
Entity Type:Individual
Prefix:
First Name:SHAHNAZ
Middle Name:
Last Name:FATTEH
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 1:817 S UNIVERSITY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3309
Mailing Address - Country:US
Mailing Address - Phone:954-723-0334
Mailing Address - Fax:954-723-0807
Practice Address - Street 1:817 S UNIVERSITY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-3309
Practice Address - Country:US
Practice Address - Phone:954-723-0334
Practice Address - Fax:954-723-0807
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63504207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374011100Medicaid
23596ZMedicare PIN
FL374011100Medicaid