Healthcare Provider Details

I. General information

NPI: 1457607111
Provider Name (Legal Business Name): YASSER SHAHROUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 KATHLEEN RD
LAKELAND FL
33810-3077
US

IV. Provider business mailing address

1324 LAKELAND HILLS BLVD MANAGED CARE DEPT
LAKELAND FL
33805
US

V. Phone/Fax

Practice location:
  • Phone: 863-687-1303
  • Fax: 863-687-1303
Mailing address:
  • Phone: 862-867-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number27349
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number27349
License Number StateWV
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME144912
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: