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General NPI Number Information
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NPI Number | 1013078823
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Entity Type | Individual
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Provider Name | MUJIB SHUAYB
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Gender | Male
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 900 N SUNCOAST BLVD
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-5472
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Country | US
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Telephone | 352-795-0151
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Fax |
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Provider Business Mailing Address
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Address Line | 1770 N WICKHAM RD
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City | MELBOURNE
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State | FL
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Zip | 32935-8122
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN17734
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License Number State | FL
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