Individual
SHAZIA SIDDIQUI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
895 TIGER BLVD, CLEMSON, SC 29631-1480
(864) 512-7257
(864) 654-7672
Mailing address
PO BOX 100174, COLUMBIA, SC 29202-3174
(864) 512-7257
(864) 654-7672
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34652
SC
207Q00000X
Family Medicine Physician
LL34652
SC
Other
Enumeration date
06/12/2012
Last updated
01/05/2023
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