MEDICARE: DR. SHALOMIM YAHOSHUA HALAHAWI NMD DPH DFM D.TCM

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	101YP1600X	Pastoral Counselor	012710311976-PCFL	FL
2	101YP1600X	Pastoral Counselor	LIC NO.10311976LPM	GA
3	133NN1002X	Nutrition Education Nutritionist		GA
4	133NN1002X	Nutrition Education Nutritionist	NUT-012710311976FL	FL
5	133NN1002X	Nutrition Education Nutritionist	10311976PNNT	ZZ
6	171100000X	Acupuncturist	MFS1102210797	ZZ
7	174H00000X	Health Educator	HE-04012016-103176	FL
8	174H00000X	Health Educator	750127-1076PHE	ZZ
9	175F00000X	Naturopath	NAT#1000888	DC
10	175L00000X	Homeopath	0127-HOM-1031976FLA	FL
11	175L00000X	Homeopath	LIC.10311976P-MD	GA
12	2083P0901X	Public Health & General Preventive Medicine Physician	D-1130-M1PK	ZZ
13	364S00000X	Clinical Nurse Specialist	SDCL/MIIM/ISD1208588	ZZ
14	207Q00000X	Family Medicine Physician	SDC-1208589	ZZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LIC#10311976PMD	OTHER	GA	AMERICAN ASSOCIATION OF INTEGRATIVE & PASTORAL MEDICINE
2	11D2003757	OTHER	GA	GEORGIA DEPARTMENT OF COMMUNITY HEALTH CLIA REGISTRATION

General Provider Information

NPI Number	:	1366778177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHALOMIM YAHOSHUA HALAHAWI NMD DPH DFM D.TCM

Provider Business Mailing Address
First Line	:	1080 CYPRESS PKWY
Second Line	:	1108
City	:	KISSIMMEE
State	:	FL
Zip	:	34759-3328
Country	:	US
Telephone Number	:	678-909-4422
Fax Number	:	866-357-6267

Provider Business Practice Location Address
First Line	:	4827 OLD NATIONAL HWY # 10016
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30337-6234
Country	:	US
Telephone Number	:	678-909-4422
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/29/2009
Last Update Date	:	04/14/2020

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