Healthcare Provider Details

I. General information

NPI: 1134154289
Provider Name (Legal Business Name): MEENA A SHAHANE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 LEARNING WAY
TALLAHASSEE FL
32306-4178
US

IV. Provider business mailing address

960 LEARNING WAY
TALLAHASSEE FL
32306-4178
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-1802
  • Fax: 850-644-4251
Mailing address:
  • Phone: 850-644-1802
  • Fax: 850-644-4251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME0037278
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME0037278
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: