Provider Demographics
NPI:1780681049
Name:AHMED, SHAHNAZ (MD)
Entity Type:Individual
Prefix:
First Name:SHAHNAZ
Middle Name:
Last Name:AHMED
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 1:4401 CORTEZ RD W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3142
Mailing Address - Country:US
Mailing Address - Phone:941-357-5550
Mailing Address - Fax:941-792-7152
Practice Address - Street 1:4401 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3142
Practice Address - Country:US
Practice Address - Phone:941-357-5550
Practice Address - Fax:941-792-7152
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75729207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254256100Medicaid
FLG15607Medicare UPIN
FL43984YMedicare PIN