Provider Demographics
NPI:1851399315
Name:AHMED, SHAHEDA R (MD)
Entity Type:Individual
Prefix:
First Name:SHAHEDA
Middle Name:R
Last Name:AHMED
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 1:5620 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1501
Mailing Address - Country:US
Mailing Address - Phone:419-866-1804
Mailing Address - Fax:
Practice Address - Street 1:2222 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2673
Practice Address - Country:US
Practice Address - Phone:419-251-4534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034058207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000192606OtherANTHEM
MI4390441Medicaid
OH0696162Medicaid
OHAH4038571Medicare PIN
F06230Medicare UPIN
OH4038571Medicare PIN