Provider Demographics
NPI:1396068060
Name:SHAHZAAD, SHAZIA
Entity type:Individual
Prefix:
First Name:SHAZIA
Middle Name:
Last Name:SHAHZAAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 W FILLMORE ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-4615
Mailing Address - Country:US
Mailing Address - Phone:312-929-2317
Mailing Address - Fax:
Practice Address - Street 1:1441 W FILLMORE ST
Practice Address - Street 2:UNIT B
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-4615
Practice Address - Country:US
Practice Address - Phone:312-929-2317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-09
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL126.066246390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program