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General NPI Number Information
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NPI Number | 1083203483
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Entity Type | Individual
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Provider Name | GERGES B SHANAD
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Gender | Male
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Dates
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Enumeration Date | 01/11/2021
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Last Update Date | 01/11/2021
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Provider Practice Location Address
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Address Line | 13260 US HIGHWAY 1
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City | SEBASTIAN
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State | FL
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Zip | 32958-3750
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Country | US
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Telephone | 772-571-6496
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Fax | 772-918-8783
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Provider Business Mailing Address
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Address Line | 360 21ST CT SW
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City | VERO BEACH
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State | FL
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Zip | 32962-3368
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Country | US
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Telephone | 772-713-9131
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Fax | 772-918-8783
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS36454
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License Number State | FL
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