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General NPI Number Information
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NPI Number | 1093860199
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Entity Type | Organization
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Legal Business Name | SAFWAN SHAMS,M.D.,P.A.
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Dates
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Enumeration Date | 01/25/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 61 MEMORIAL MEDICAL PKWY SUITE 1-800A
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City | PALM COAST
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State | FL
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Zip | 32164-5981
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Country | US
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Telephone | 386-586-1810
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Fax | 386-586-1811
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Provider Business Mailing Address
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Address Line | PO BOX 883
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City | BUNNELL
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State | FL
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Zip | 32110-0883
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Country | US
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Telephone | 386-586-1810
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Fax | 386-586-1811
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAFWAN SHAMS
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Credential | M.D.
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Telephone | 386-586-1810
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME036504
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME036504
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License Number State | FL
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