Healthcare Provider Details

I. General information

NPI: 1548400633
Provider Name (Legal Business Name): PREMIER PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 352-671-6741
  • Fax: 352-671-6742
Mailing address:
  • Phone: 352-671-6741
  • Fax: 352-671-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberME96086
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberME96086
License Number StateFL

VIII. Authorized Official

Name: DR. SHAHAB EUNUS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 352-671-6741