MEDICARE: SHAHLA MEDICAL ASSOCIATES PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235317397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAHLA MEDICAL ASSOCIATES PA

Provider Business Mailing Address
First Line	:	1141 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3445
Country	:	US
Telephone Number	:	904-249-3820
Fax Number	:	904-249-3390

Provider Business Practice Location Address
First Line	:	1141 BEACH BLVD
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-3445
Country	:	US
Telephone Number	:	904-249-3820
Fax Number	:	904-249-3390

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SEAN SHAHLA
Credential	:	MD
Telephone Number	:	904-249-3820

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	11/08/2011

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Directions to “SHAHLA MEDICAL ASSOCIATES PA ” Practice Location

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