MEDICARE: AFFILIATED FOOT & ANKLE PROVIDERS, INC

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	305R00000X	Preferred Provider Organization

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45842	OTHER	FL	IPA AGREEMENT

General Provider Information

NPI Number	:	1568015865
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFILIATED FOOT & ANKLE PROVIDERS, INC

Provider Business Mailing Address
First Line	:	232 BULLARD PKWY
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-5512
Country	:	US
Telephone Number	:	813-985-1665
Fax Number	:	813-985-3045

Provider Business Practice Location Address
First Line	:	232 BULLARD PKWY
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-5512
Country	:	US
Telephone Number	:	813-985-1665
Fax Number	:	813-985-3045

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STANLEY S SHAMA
Credential	:	DPM
Telephone Number	:	813-985-1665

Provider Enumeration Date	:	07/17/2019
Last Update Date	:	07/17/2019

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