Provider Demographics
NPI:1528152188
Name:HUSAIN, SHAKIRA (MD)
Entity type:Individual
Prefix:
First Name:SHAKIRA
Middle Name:
Last Name:HUSAIN
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 1:100 WHETSTONE PL
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5774
Mailing Address - Country:US
Mailing Address - Phone:904-296-1160
Mailing Address - Fax:904-483-5852
Practice Address - Street 1:100 WHETSTONE PL
Practice Address - Street 2:STE 206
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5774
Practice Address - Country:US
Practice Address - Phone:904-217-3545
Practice Address - Fax:904-562-3282
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00287731OtherRAILROAD MEDICARE
FL28290OtherBCBS
FL379471700Medicaid
FL28290ZMedicare ID - Type Unspecified
FL379471700Medicaid