Healthcare Provider Details

I. General information

NPI: 1457812273
Provider Name (Legal Business Name): SHANE DEVANAND NAIDOO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9445 HARDING AVE
SURFSIDE FL
33154-2803
US

IV. Provider business mailing address

9445 HARDING AVE
SURFSIDE FL
33154-2803
US

V. Phone/Fax

Practice location:
  • Phone: 305-537-6396
  • Fax: 305-686-1965
Mailing address:
  • Phone: 732-762-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD26260
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA12413100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME160319
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: