Basic Information
| Provider Information | |||||||||
| NPI: | 1245666759 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHEHZADI NAGRA MD PLLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SHEHZADI NAGRA MD | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1601 BROOK AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763015619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9407239226 | ||||||||
| FaxNumber: | 9407239217 | ||||||||
| Practice Location | |||||||||
| Address1: | 1601 BROOK AVE | ||||||||
| Address2: | |||||||||
| City: | WICHITA FALLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 763015619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9407239226 | ||||||||
| FaxNumber: | 9407239217 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2013 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| AuthorizedOfficialLastName: | BROOKING | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9407239226 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | CMOM,CMIS | ||||||||
| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | P4212 | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.