Provider Demographics
NPI:1396724407
Name:SHAHID, SUFIA B (MD)
Entity type:Individual
Prefix:
First Name:SUFIA
Middle Name:B
Last Name:SHAHID
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 1:4714 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607-2247
Mailing Address - Country:US
Mailing Address - Phone:757-380-8709
Mailing Address - Fax:757-928-0902
Practice Address - Street 1:4714 MARSHALL AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23607-2247
Practice Address - Country:US
Practice Address - Phone:757-380-8709
Practice Address - Fax:757-928-0902
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039270208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
F76608Medicare UPIN