Healthcare Provider Details

I. General information

NPI: 1710948971
Provider Name (Legal Business Name): KHALED OMAR SHEBANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 SE MAGNOLIA EXT SUITE 201
OCALA FL
34471-4463
US

IV. Provider business mailing address

1500 SE MAGNOLIA EXT STE 201
OCALA FL
34471-4461
US

V. Phone/Fax

Practice location:
  • Phone: 352-620-2711
  • Fax: 352-620-2712
Mailing address:
  • Phone: 352-620-2711
  • Fax: 352-620-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME95263
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number87219-20
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME95263
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: