Healthcare Provider Details

I. General information

NPI: 1154259273
Provider Name (Legal Business Name): SHAITIA MARTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

92 W MILLER ST
ORLANDO FL
32806-2032
US

IV. Provider business mailing address

6401 LAKES ROCK DR UNIT 218
RALEIGH NC
27609-3248
US

V. Phone/Fax

Practice location:
  • Phone: 407-649-6876
  • Fax:
Mailing address:
  • Phone: 210-749-9097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: