Provider Demographics
NPI:1932163888
Name:RIAZUDEEN, SHAHUL HAMEED (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAHUL
Middle Name:HAMEED
Last Name:RIAZUDEEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5849
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33571-5849
Mailing Address - Country:US
Mailing Address - Phone:813-633-1100
Mailing Address - Fax:813-633-1152
Practice Address - Street 1:16541 S US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-2032
Practice Address - Country:US
Practice Address - Phone:813-633-1100
Practice Address - Fax:813-633-1152
Is Sole Proprietor?:No
Enumeration Date:2006-04-15
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL27785300Medicaid
FL91589OtherBLUE CROSS/BLUE SHIELD OF FLORIDA
FL0429725OtherUNITED HEALTHCARE/EVERCARE
FL9234745OtherCIGNA
FL7177011OtherAETNA
FLG97725Medicare UPIN
FLP00426169Medicare PIN
FL91589OtherBLUE CROSS/BLUE SHIELD OF FLORIDA