Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 2018017165 | MO |
Y | 2080P0203X | Pediatric Critical Care Doctor | 2018017165 | MO |
NPI | 1114419850 |
---|---|
Provider Name | Shahzad Bin Waheed |
First Address | St.john's, NEWFOUNDLAND AND LABRADOR A1A 0A4 |
Second Address | Columbia, MO 65201-6626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2018 |
Last Update Date | 30/05/2018 |