Provider Demographics
NPI:1972171080
Name:MIZAN, SHAHIDA BINTI (MD)
Entity type:Individual
Prefix:
First Name:SHAHIDA
Middle Name:BINTI
Last Name:MIZAN
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:UNIVERSITY OF MARYLAND MEDICAL CENTER GME OFFICE
Mailing Address - Street 2:110 SOUTH PACA STREET, 8TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-328-0996
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF MARYLAND MEDICAL CENTER GME OFFICE
Practice Address - Street 2:110 SOUTH PACA STREET, 8TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-328-0996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101279032390200000X
MDD0102954390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program