Provider Demographics
NPI:1689605503
Name:AKHTAR, SHAHEDA (MD)
Entity Type:Individual
Prefix:
First Name:SHAHEDA
Middle Name:
Last Name:AKHTAR
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 1:4564 THORNLEA RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1241
Mailing Address - Country:US
Mailing Address - Phone:407-721-0518
Mailing Address - Fax:407-240-8185
Practice Address - Street 1:2500 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-3709
Practice Address - Country:US
Practice Address - Phone:407-275-2203
Practice Address - Fax:407-282-7012
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME502512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07600OtherBCBS