Healthcare Provider Details

I. General information

NPI: 1366778177
Provider Name (Legal Business Name): SHALOMIM YAHOSHUA HALAHAWI NMD DPH DFM D.TCM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 09/29/2026
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4827 OLD NATIONAL HWY # 10016
COLLEGE PARK GA
30337-6234
US

IV. Provider business mailing address

1080 CYPRESS PKWY 1108
KISSIMMEE FL
34759-3328
US

V. Phone/Fax

Practice location:
  • Phone: 678-909-4422
  • Fax:
Mailing address:
  • Phone: 678-909-4422
  • Fax: 866-357-6267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberSDCL/MIIM/ISD1208588
License Number StateZZ
# 2
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number012710311976-PCFL
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License NumberLIC NO.10311976LPM
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberNUT-012710311976FL
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number10311976PNNT
License Number StateZZ
# 7
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberMFS1102210797
License Number StateZZ
# 8
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNAT#1000888
License Number StateDC
# 9
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number0127-HOM-1031976FLA
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License NumberLIC.10311976P-MD
License Number StateGA
# 11
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSDC-1208589
License Number StateZZ
# 12
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberD-1130-M1PK
License Number StateZZ
# 13
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberHE-04012016-103176
License Number StateFL
# 14
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number750127-1076PHE
License Number StateZZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: