Provider Demographics
NPI:1033355987
Name:HYDER, SHAHAB (MD)
Entity type:Individual
Prefix:
First Name:SHAHAB
Middle Name:
Last Name:HYDER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4715 S LAMAR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SUNSET VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1308
Mailing Address - Country:US
Mailing Address - Phone:512-442-1996
Mailing Address - Fax:512-441-1093
Practice Address - Street 1:4715 S LAMAR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SUNSET VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78745-1308
Practice Address - Country:US
Practice Address - Phone:512-442-1996
Practice Address - Fax:512-441-1093
Is Sole Proprietor?:No
Enumeration Date:2008-12-24
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP9595207R00000X
FL11634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX337857203Medicaid
TX337857204Medicaid
TX337857205Medicaid
TX337857202Medicaid
TX358794YKXVMedicare PIN
TX337857202Medicaid
TX358794YKXYMedicare PIN
TX358794YLP2Medicare PIN
TX337857203Medicaid