Provider Demographics
NPI:1942882378
Name:YUNUS, SHAZADA KAWKAB (MD)
Entity Type:Individual
Prefix:
First Name:SHAZADA
Middle Name:KAWKAB
Last Name:YUNUS
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 1:6841 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-4418
Mailing Address - Country:US
Mailing Address - Phone:904-862-2175
Mailing Address - Fax:904-862-2330
Practice Address - Street 1:6841 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-4418
Practice Address - Country:US
Practice Address - Phone:904-862-2175
Practice Address - Fax:904-862-2330
Is Sole Proprietor?:No
Enumeration Date:2021-04-26
Last Update Date:2024-03-12
Deactivation Date:2022-02-24
Deactivation Code:
Reactivation Date:2022-08-17
Provider Licenses
StateLicense IDTaxonomies
FLME166100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine