Provider Demographics
NPI:1255398707
Name:SHUJAAT, HAJIRA M (OD)
Entity type:Individual
Prefix:
First Name:HAJIRA
Middle Name:M
Last Name:SHUJAAT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HAJIRA
Other - Middle Name:
Other - Last Name:MOINUDDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:160 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4798
Mailing Address - Country:US
Mailing Address - Phone:407-834-7776
Mailing Address - Fax:407-834-0973
Practice Address - Street 1:10000 WEST COLONIAL DR.
Practice Address - Street 2:SUITE 183
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3434
Practice Address - Country:US
Practice Address - Phone:407-834-7776
Practice Address - Fax:407-834-0973
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4096152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621123200Medicaid
FLU8318TMedicare PIN
FLU8318OMedicare PIN
FLU8318UMedicare PIN
FLU8318XMedicare PIN
FLU8318YMedicare PIN
FLU8318ZMedicare PIN
FL621123200Medicaid
FLU8318SMedicare PIN
FLU8318VMedicare PIN
V10426Medicare UPIN