Provider Demographics
NPI:1073405304
Name:SHAZIA BASHIR MD PLLC
Entity type:Organization
Organization Name:SHAZIA BASHIR MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASHIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:314-479-9243
Mailing Address - Street 1:707 1ST ST S APT 604
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32250-6670
Mailing Address - Country:US
Mailing Address - Phone:314-479-9243
Mailing Address - Fax:
Practice Address - Street 1:1680 OSCEOLA ELEMENTARY RD STE A
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-5942
Practice Address - Country:US
Practice Address - Phone:314-479-9243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-21
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Single Specialty