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General NPI Number Information
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NPI Number | 1205125069
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Entity Type | Organization
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Legal Business Name | NICHI ENTERPRISES INC
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Dates
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Enumeration Date | 04/01/2011
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Last Update Date | 08/25/2011
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Provider Practice Location Address
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Address Line | 1151 BLACKWOOD AVE SUITE 170
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City | OCOEE
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State | FL
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Zip | 34761-4550
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Country | US
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Telephone | 407-347-8339
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Fax | 407-347-8394
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Provider Business Mailing Address
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Address Line | 1151 BLACKWOOD AVE SUITE 170
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City | OCOEE
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State | FL
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Zip | 34761-4550
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Country | US
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Telephone | 407-347-8339
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Fax | 407-347-8394
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SYED HADI SHAH
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Credential | MD
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Telephone | 407-347-8339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | ME108175
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License Number State | FL
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