Provider Demographics
NPI:1952411969
Name:SHADEED, NADIRA SOAD (OD, FCOVD)
Entity Type:Individual
Prefix:DR
First Name:NADIRA
Middle Name:SOAD
Last Name:SHADEED
Suffix:
Gender:F
Credentials:OD, FCOVD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 HABERSHAM CLUB DR
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8003
Mailing Address - Country:US
Mailing Address - Phone:678-448-2696
Mailing Address - Fax:
Practice Address - Street 1:2055 HAMILTON CREEK PKWY STE 120
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7205
Practice Address - Country:US
Practice Address - Phone:770-904-0979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2355152W00000X, 152WV0400X
SC1440152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD14401Medicaid
SCV09945Medicare UPIN
SCD14401Medicaid