Shazia Tabasum Malik, NURSE PRACTITIONER

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

95022173 Issued in CA

Practice address

1225 M St
Fresno, CA 93721-1805

Phone

(550) 600-9300

NPI assigned

Nov 15, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Electronic endpoints 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Revitalize Wellness Center Inc

  • Psychiatric/Mental Health Nurse Practitioner
  • Fresno, CA
  • NPI 1003637448

  Single Specialty

  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1573776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776124800000",
    "number": "1104461938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5170 N FLOYD AVE",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937239435",
            "telephone_number": "559-421-5955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 M ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211805",
            "telephone_number": "550-600-9300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2501 W Shaw Ave Ste 101",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937113307",
            "country_code": "US",
            "telephone_number": "559-507-3760 x73760",
            "fax_number": "539-238-2199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALIK",
        "first_name": "SHAZIA",
        "middle_name": "TABASUM",
        "name_prefix": "Mrs.",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-11-15",
        "last_updated": "2026-04-14",
        "certification_date": "2026-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95022173",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95022173",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "748392",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Fresno",
            "affiliation": "N",
            "endpointDescription": "fresno",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Fresno",
            "address_1": "5170 N Floyd Ave",
            "city": "Fresno",
            "state": "CA",
            "country_code": "US",
            "postal_code": "937239435",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Fresno",
            "affiliation": "N",
            "endpointDescription": "fresno",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Fresno",
            "address_1": "5170 N Floyd Ave",
            "city": "Fresno",
            "state": "CA",
            "country_code": "US",
            "postal_code": "937239435",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "admin@revitalizewci.com",
            "affiliation": "N",
            "endpointDescription": "business email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "2501 W Shaw Ave Ste 101",
            "city": "Fresno",
            "state": "CA",
            "country_code": "US",
            "postal_code": "937113307",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Robina Chandhok Malhotra, R.PH
• Cima Pius Maliakal, MD
• Kathryn Abigail Malicoat, SLP
• Aisha Malik, PA-C
• Ammar Malik
• Malintze Gutierrez, D.O., Inc.
• Malintze Gutierrez, Inc.
• Gail Maureen Mallard-Warren, MD
• Myla Mallari
• Varun Mallela

• Psychiatric/Mental Health Nurse Practitioner in Fresno, CA
• Providers in Fresno, CA by specialty
• Psychiatric/Mental Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.