Provider Demographics
NPI:1013284520
Name:SHAHNEAZ, MASOOD
Entity Type:Individual
Prefix:
First Name:MASOOD
Middle Name:
Last Name:SHAHNEAZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 W ATLANTIC BLVD
Mailing Address - Street 2:NO 913
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-1752
Mailing Address - Country:US
Mailing Address - Phone:954-979-2521
Mailing Address - Fax:
Practice Address - Street 1:4309 W ATLANTIC BLVD
Practice Address - Street 2:NO 913
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-1752
Practice Address - Country:US
Practice Address - Phone:954-979-2521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35524183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist