Provider Demographics
NPI:1295398261
Name:SHUKOOR, SHEHBAZ SYED (MD)
Entity type:Individual
Prefix:DR
First Name:SHEHBAZ
Middle Name:SYED
Last Name:SHUKOOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:7260 CLARINGTON COVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38671
Mailing Address - Country:US
Mailing Address - Phone:901-767-0101
Mailing Address - Fax:901-767-0304
Practice Address - Street 1:7620 CLARINGTON COVE
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38671
Practice Address - Country:US
Practice Address - Phone:901-767-0101
Practice Address - Fax:901-767-0304
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70651207RN0300X
MS33111207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology