Provider Demographics
NPI:1871159541
Name:BANGASH, SHIDA (MD)
Entity type:Individual
Prefix:MRS
First Name:SHIDA
Middle Name:
Last Name:BANGASH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 CHELSEA RD.
Mailing Address - Street 2:
Mailing Address - City:KITCHENER
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:N2B 1H8
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 E 50TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4920
Practice Address - Country:US
Practice Address - Phone:417-556-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2023-10-27
Deactivation Date:2020-01-13
Deactivation Code:
Reactivation Date:2020-01-27
Provider Licenses
StateLicense IDTaxonomies
MO2023012100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine