Healthcare Provider Details

I. General information

NPI: 1598570798
Provider Name (Legal Business Name): MAMMOCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/16/2025
Certification Date: 02/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 NW 11TH PL
GAINESVILLE FL
32605-4216
US

IV. Provider business mailing address

14191 NW 166TH TER UNIT 2
ALACHUA FL
32615-8173
US

V. Phone/Fax

Practice location:
  • Phone: 352-999-3553
  • Fax:
Mailing address:
  • Phone: 319-535-0465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAFIK N WASSEF
Title or Position: PRESIDENT
Credential: MD
Phone: 319-535-0465