Healthcare Provider Details

I. General information

NPI: 1114918729
Provider Name (Legal Business Name): SMH PHYSICIAN SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 08/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 S EAST AVE SUITE 208
SARASOTA FL
34239-2340
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-953-2295
  • Fax: 941-366-3815
Mailing address:
  • Phone: 941-953-2295
  • Fax: 941-366-3815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: MS. DELLA K SHAW
Title or Position: COO
Credential:
Phone: 941-917-8720