| Doctor Name: | SHAZIA MIRZA |
| NPI Number: | 1396008322 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | IMH8941 |
| Business Practice Address: | 5766 S Semoran Blvd Orlando, FL - 328224818 |
| Business Phone Number: | 4078962323 |
| Business Fax Number: | |
| Mailing Address: | 3482 Rolling Hills Ln, APOPKA |
| State: | FL |
| Postal Code: | 327124780 |
| Phone Number: | 4076211155 |
| Fax Number: | |
| NPI Enumeration Date: | 06/25/2012 |
| NPI Last Update Date: | 06/25/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | IMH8941 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |