Healthcare Provider Details

I. General information

NPI: 1144508441
Provider Name (Legal Business Name): SHAHENAZ SULIMAN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2011
Last Update Date: 03/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11707 LAKEWOOD DR
HUDSON FL
34669-2906
US

IV. Provider business mailing address

207 8TH ST E
ST PETERSBURG FL
33715-2248
US

V. Phone/Fax

Practice location:
  • Phone: 727-379-9250
  • Fax: 727-856-9250
Mailing address:
  • Phone: 727-379-9250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number60604
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN14950
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: