Healthcare Provider Details

I. General information

NPI: 1144892720
Provider Name (Legal Business Name): SHAHRIAR SHAHAMI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6323 CORPORATE CT STE A
FORT MYERS FL
33919-3518
US

IV. Provider business mailing address

6323 CORPORATE CT STE A
FORT MYERS FL
33919-3518
US

V. Phone/Fax

Practice location:
  • Phone: 301-272-4937
  • Fax: 239-482-8531
Mailing address:
  • Phone: 239-482-5311
  • Fax: 239-482-8531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN32059
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: