Healthcare Provider Details

I. General information

NPI: 1881513778
Provider Name (Legal Business Name): SUMAYYAH SHAFIUDDIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 S VOLUSIA AVE
ORANGE CITY FL
32763-7022
US

IV. Provider business mailing address

1025 S VOLUSIA AVE
ORANGE CITY FL
32763-7022
US

V. Phone/Fax

Practice location:
  • Phone: 386-775-9933
  • Fax:
Mailing address:
  • Phone: 386-775-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN32178
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN32178
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: