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General NPI Number Information
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NPI Number | 1477674232
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Entity Type | Individual
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Provider Name | SHADI AYYOUB
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 400 HEALTH PARK BLVD STE 300
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City | ST AUGUSTINE
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State | FL
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Zip | 32086-5784
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Country | US
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Telephone | 904-819-4082
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Fax | 904-819-5156
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Provider Business Mailing Address
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Address Line | PO BOX 3123
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City | ST AUGUSTINE
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State | FL
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Zip | 32085-3123
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Country | US
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Telephone | 904-819-4082
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Fax | 904-819-5156
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 44249
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 37193
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME119332
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License Number State | FL
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