Healthcare Provider Details

I. General information

NPI: 1891097747
Provider Name (Legal Business Name): SHAN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15251 NE 18TH AVE SUITE 9 AND 11
NORTH MIAMI BEACH FL
33162-6039
US

IV. Provider business mailing address

15251 NE 18TH AVE SUITE 9 AND 11
NORTH MIAMI BEACH FL
33162-6039
US

V. Phone/Fax

Practice location:
  • Phone: 305-627-3103
  • Fax: 305-627-3421
Mailing address:
  • Phone: 305-627-3103
  • Fax: 305-627-3421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. ALI MANDSAURWALA
Title or Position: OWNER
Credential:
Phone: 305-627-3103