Healthcare Provider Details

I. General information

NPI: 1639740624
Provider Name (Legal Business Name): PREMIER PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2021
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14141 E HIGHWAY 40
SILVER SPRINGS FL
34488-3910
US

IV. Provider business mailing address

7960 SW 60TH AVE STE 100
OCALA FL
34476-6457
US

V. Phone/Fax

Practice location:
  • Phone: 352-512-0466
  • Fax: 352-512-0374
Mailing address:
  • Phone: 352-671-6741
  • Fax: 352-671-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SHAHAB EUNUS
Title or Position: CEO
Credential: MD
Phone: 352-671-6741