Provider Demographics
NPI:1992816995
Name:SHAFIQ, MUSSARAT (MD)
Entity type:Individual
Prefix:
First Name:MUSSARAT
Middle Name:
Last Name:SHAFIQ
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 1:2403 N LAURENT ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4119
Mailing Address - Country:US
Mailing Address - Phone:361-579-0315
Mailing Address - Fax:361-579-0325
Practice Address - Street 1:400 HOSPITAL DR
Practice Address - Street 2:STE 208
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75110-2489
Practice Address - Country:US
Practice Address - Phone:903-654-4564
Practice Address - Fax:903-654-6837
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93798208000000X
TXN4737208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CF759OtherBLUE CROSS
OH000000552361OtherANTHEM/BCBS
FL273813900Medicaid
OH4229961Medicare PIN
FLSH009419Medicare ID - Type Unspecified
FL273813900Medicaid