Healthcare Provider Details

I. General information

NPI: 1770865917
Provider Name (Legal Business Name): IRA FIALKO DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/02/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6171 W GULF TO LAKE HWY
CRYSTAL RIVER FL
34429-2679
US

IV. Provider business mailing address

7960 SW 60TH AVE STE 100
OCALA FL
34476-6409
US

V. Phone/Fax

Practice location:
  • Phone: 352-563-0220
  • Fax: 352-563-0706
Mailing address:
  • Phone: 352-671-6741
  • Fax: 352-671-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAHAB EUNUS
Title or Position: OWNER
Credential: MD
Phone: 352-671-6741