Provider Demographics
NPI:1023104098
Name:ABBAS, SHAHIDA M (MD)
Entity type:Individual
Prefix:MRS
First Name:SHAHIDA
Middle Name:M
Last Name:ABBAS
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 1:10 CINDY ST
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-3002
Mailing Address - Country:US
Mailing Address - Phone:732-607-2447
Mailing Address - Fax:732-607-2449
Practice Address - Street 1:10 CINDY ST
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3002
Practice Address - Country:US
Practice Address - Phone:732-607-2447
Practice Address - Fax:732-607-2449
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06412700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7753306Medicaid
NJ7753306Medicaid