Healthcare Provider Details

I. General information

NPI: 1508681685
Provider Name (Legal Business Name): SHAMIM BEGAM NEDUVANCHERY BDS, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR
GAINESVILLE FL
32610-3006
US

IV. Provider business mailing address

5196 SW 47TH LN
GAINESVILLE FL
32608-0244
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-5800
  • Fax:
Mailing address:
  • Phone: 904-549-3353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License NumberDRPM2616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: