Healthcare Provider Details

I. General information

NPI: 1457354474
Provider Name (Legal Business Name): SHAHINA JAVEED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4904 MOOG RD
HOLIDAY FL
34690-1857
US

IV. Provider business mailing address

4904 MOOG RD
HOLIDAY FL
34690-1857
US

V. Phone/Fax

Practice location:
  • Phone: 727-934-5765
  • Fax:
Mailing address:
  • Phone: 727-934-5765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0070915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: