Healthcare Provider Details

I. General information

NPI: 1972712750
Provider Name (Legal Business Name): SUDAH SHAHEB
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MICCOSUKEE HEALTH DEPARTMENT 37790 SW 8TH ST,
MIAMI FL
33194
US

IV. Provider business mailing address

7627 SW 102ND PL
MIAMI FL
33173-3960
US

V. Phone/Fax

Practice location:
  • Phone: 305-223-8380
  • Fax:
Mailing address:
  • Phone: 786-328-9186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number21038
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: