Healthcare Provider Details

I. General information

NPI: 1457715161
Provider Name (Legal Business Name): MAHMOUD MAHMOUD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MAHMOUD SHEHATA M.D.

II. Dates (important events)

Enumeration Date: 04/08/2016
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 SE RIVERSIDE DR STE 203
STUART FL
34994-2579
US

IV. Provider business mailing address

509 SE RIVERSIDE DR STE 203
STUART FL
34994-2579
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-5945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number16569
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number67265
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number152567
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: