Healthcare Provider Details

I. General information

NPI: 1205125069
Provider Name (Legal Business Name): NICHI ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 BLACKWOOD AVE SUITE 170
OCOEE FL
34761-4550
US

IV. Provider business mailing address

1151 BLACKWOOD AVE SUITE 170
OCOEE FL
34761-4550
US

V. Phone/Fax

Practice location:
  • Phone: 407-347-8339
  • Fax: 407-347-8394
Mailing address:
  • Phone: 407-347-8339
  • Fax: 407-347-8394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME108175
License Number StateFL

VIII. Authorized Official

Name: DR. SYED HADI SHAH
Title or Position: PRESIDENT
Credential: MD
Phone: 407-347-8339