Provider Demographics
NPI:1669549655
Name:SIDDIQUI, SHAHIDA (MD)
Entity type:Individual
Prefix:
First Name:SHAHIDA
Middle Name:
Last Name:SIDDIQUI
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 1:80 BROPHY DR
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08638-1242
Mailing Address - Country:US
Mailing Address - Phone:609-532-1794
Mailing Address - Fax:609-882-1038
Practice Address - Street 1:10 SOUTHARD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08609-1020
Practice Address - Country:US
Practice Address - Phone:609-394-3202
Practice Address - Fax:609-278-6139
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA038453002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0193062Medicaid