Provider Demographics
NPI:1104239995
Name:SHEHATA, FADIA ZAKY (MD)
Entity type:Individual
Prefix:
First Name:FADIA
Middle Name:ZAKY
Last Name:SHEHATA
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 1:19012 VIST GRANDE WY
Mailing Address - Street 2:
Mailing Address - City:PORTERRANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19012 VIST GRANDE WY
Practice Address - Street 2:
Practice Address - City:PORTERRANCH
Practice Address - State:CA
Practice Address - Zip Code:91326
Practice Address - Country:US
Practice Address - Phone:818-368-8384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE34770207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology