Healthcare Provider Details

I. General information

NPI: 1538271952
Provider Name (Legal Business Name): SHAMA HUSSAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5412 CURRY FORD RD
OLRANDO FL
32812
US

IV. Provider business mailing address

5412 CURRY FORD RD
OLRANDO FL
32812
US

V. Phone/Fax

Practice location:
  • Phone: 407-658-7882
  • Fax: 407-658-7995
Mailing address:
  • Phone: 407-658-7882
  • Fax: 407-658-7995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberME94436
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME94436
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207KI0005X
TaxonomyClinical & Laboratory Immunology (Allergy & Immunology) Physician
License NumberME94436
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME94436
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: