Provider Demographics
NPI:1770681405
Name:QURESHI, SHAISTA (MD)
Entity Type:Individual
Prefix:
First Name:SHAISTA
Middle Name:
Last Name:QURESHI
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 1:2001 VAIL AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1248
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:610 AIRPORT RD SW STE 100
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-4304
Practice Address - Country:US
Practice Address - Phone:256-585-1567
Practice Address - Fax:256-527-0718
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-02190207Q00000X, 207Q00000X
ALL.5581VP207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNC2845Medicaid
MA110074206AMedicaid
NC1770681405Medicaid
SCNC2845Medicaid