1164027579 NPI number — SHAJJIA AHMED FNP

Table of content: SHAJJIA AHMED FNP (NPI 1164027579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164027579 NPI number — SHAJJIA AHMED FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AHMED
Provider First Name:
SHAJJIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164027579
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6901 SNIDER PLZ
Provider Second Line Business Mailing Address:
STE 130
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75205-5649
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-696-8803
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 HILLCREST MEDICAL BLVD STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76712-8954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-202-0550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  1020474 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)