Provider Demographics
NPI:1811904238
Name:NASIR, SHAHID M (MD)
Entity type:Individual
Prefix:
First Name:SHAHID
Middle Name:M
Last Name:NASIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CORRIDOR RD UNIT 428
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32004-7718
Mailing Address - Country:US
Mailing Address - Phone:907-551-0703
Mailing Address - Fax:904-551-0709
Practice Address - Street 1:1052 PONTE VEDRA BLVD
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4015
Practice Address - Country:US
Practice Address - Phone:904-551-0703
Practice Address - Fax:904-551-0709
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD175422085R0202X
FLME933042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276663900Medicaid
FL276663900Medicaid
FLI70938Medicare UPIN