Healthcare Provider Details

I. General information

NPI: 1245076264
Provider Name (Legal Business Name): SLAYMON SHUKOOR DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2024
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 CENTER DR RM D1-17
GAINESVILLE FL
32610-4704
US

IV. Provider business mailing address

603 N 12TH ST APT 204
TAMPA FL
33602-3267
US

V. Phone/Fax

Practice location:
  • Phone: 404-313-1301
  • Fax:
Mailing address:
  • Phone: 404-313-1301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberDN29332
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: