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General NPI Number Information
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NPI Number | 1477855385
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Entity Type | Organization
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Legal Business Name | HUSAM E. SHUAYB MD PA
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Dates
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Enumeration Date | 11/29/2010
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Last Update Date | 05/09/2013
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Provider Practice Location Address
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Address Line | 11373 CORTEZ BLVD SUITE 306
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5411
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Country | US
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Telephone | 352-596-6264
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Fax |
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Provider Business Mailing Address
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Address Line | 11373 CORTEZ BLVD SUITE 306
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City | BROOKSVILLE
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State | FL
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Zip | 34613-5414
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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 | MD
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Name | HUSAM SHUAYB
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Credential |
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Telephone | 352-596-6264
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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 | ME038075
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License Number State | FL
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