Healthcare Provider Details

I. General information

NPI: 1942391099
Provider Name (Legal Business Name): SHAMEEM TAMTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 MADISON AVE W
IMMOKALEE FL
34142
US

IV. Provider business mailing address

1454 MADISON AVE W
IMMOKALEE FL
34142
US

V. Phone/Fax

Practice location:
  • Phone: 239-658-3064
  • Fax: 239-658-3175
Mailing address:
  • Phone: 239-658-3064
  • Fax: 239-658-3175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME54547
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: