Basic Information
| Provider Information | |||||||||
| NPI: | 1356579569 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NAGRA | ||||||||
| FirstName: | SHEHZADI | ||||||||
| MiddleName: | GHAZALA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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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: | 06/25/2009 | ||||||||
| LastUpdateDate: | 10/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 30911 | OK | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | P4212 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 323807302 | 05 | TX | MEDICAID |