Healthcare Provider Details

I. General information

NPI: 1467619676
Provider Name (Legal Business Name): KIDS HEALTH ALLIANCE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2008
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 NW 2ND ST STE 100
OCALA FL
34475-6234
US

IV. Provider business mailing address

7960 SW 60TH AVE STE 100
OCALA FL
34476-6457
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-5400
  • Fax: 866-260-5182
Mailing address:
  • Phone: 352-237-5400
  • Fax: 866-260-5182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. SHAHAB EUNUS
Title or Position: CEO/MEDICAL DIRECTOR
Credential: MD
Phone: 352-598-2479