MEDICARE: ALI SHAYGAN MD

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	207Q00000X	Family Medicine Physician	ME92539	FL

General Provider Information

NPI Number	:	1467435768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALI SHAYGAN MD

Provider Business Mailing Address
First Line	:	PO BOX 149374
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-9374
Country	:	US
Telephone Number	:	407-893-3905
Fax Number	:

Provider Business Practice Location Address
First Line	:	1459 LAKE BALDWIN LN
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32814-6741
Country	:	US
Telephone Number	:	407-893-3905
Fax Number	:

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

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	05/04/2010

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