Healthcare Provider Details

I. General information

NPI: 1356306419
Provider Name (Legal Business Name): PAUL EMANUEL SHUSTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 LEE BLVD
LEHIGH ACRES FL
33971-6355
US

IV. Provider business mailing address

12730 NEW BRITTANY BLVD STE 602
FORT MYERS FL
33907-4690
US

V. Phone/Fax

Practice location:
  • Phone: 239-481-5437
  • Fax: 239-481-0570
Mailing address:
  • Phone: 239-275-5522
  • Fax: 239-275-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME138747
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberD0044819
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: