Provider Demographics
NPI:1639276140
Name:SIDDIQUI, SHAHID N (MD)
Entity Type:Individual
Prefix:
First Name:SHAHID
Middle Name:N
Last Name:SIDDIQUI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26542 BROOKS CIR
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-1432
Mailing Address - Country:US
Mailing Address - Phone:702-579-5858
Mailing Address - Fax:800-890-6055
Practice Address - Street 1:43830 10TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4826
Practice Address - Country:US
Practice Address - Phone:702-579-5858
Practice Address - Fax:800-890-6055
Is Sole Proprietor?:No
Enumeration Date:2006-09-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35650207R00000X
CAA94134207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine