Provider Demographics
NPI:1639412067
Name:SHANAZ, FAZEENA (MBBS, MD)
Entity type:Individual
Prefix:
First Name:FAZEENA
Middle Name:
Last Name:SHANAZ
Suffix:
Gender:
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:FAZEENA
Other - Middle Name:
Other - Last Name:ABDUL CADER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 MEDICAL PKWY STE 409
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3746
Mailing Address - Country:US
Mailing Address - Phone:443-481-5618
Mailing Address - Fax:
Practice Address - Street 1:2000 MEDICAL PKWY STE 510
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3747
Practice Address - Country:US
Practice Address - Phone:443-481-6700
Practice Address - Fax:443-481-3998
Is Sole Proprietor?:No
Enumeration Date:2013-04-04
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAMD467982207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program