Healthcare Provider Details

I. General information

NPI: 1285950931
Provider Name (Legal Business Name): SHAHEEDAH MARIE IMANO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAHEEDAH MARIE CANTLEY MUHAMMAD MD

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2964 N STATE ROAD 7 STE 300
MARGATE FL
33063-5715
US

IV. Provider business mailing address

8850 NW 37TH DR
CORAL SPRINGS FL
33065-3081
US

V. Phone/Fax

Practice location:
  • Phone: 954-468-3080
  • Fax: 954-468-3082
Mailing address:
  • Phone: 602-402-9586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD456651
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME141612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: