Provider Demographics
NPI:1669472163
Name:DADABHOY, SHAHIDA (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHIDA
Middle Name:
Last Name:DADABHOY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAHIDA
Other - Middle Name:
Other - Last Name:SIMJEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:145 W WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-1829
Mailing Address - Country:US
Mailing Address - Phone:909-865-5555
Mailing Address - Fax:909-865-5565
Practice Address - Street 1:145 W WILLOW ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-1829
Practice Address - Country:US
Practice Address - Phone:909-865-5555
Practice Address - Fax:909-865-5565
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA513152080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A513151Medicaid
CAA51315Medicare ID - Type Unspecified
CA00A513151Medicaid