Provider Demographics
NPI:1265099360
Name:SHAHEED, INTISAR SHAZIA (PA-C)
Entity type:Individual
Prefix:
First Name:INTISAR
Middle Name:SHAZIA
Last Name:SHAHEED
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8651 ADAMSTOWN WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4506
Mailing Address - Country:US
Mailing Address - Phone:916-208-5365
Mailing Address - Fax:
Practice Address - Street 1:8651 ADAMSTOWN WAY
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4506
Practice Address - Country:US
Practice Address - Phone:916-208-5365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant