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General NPI Number Information
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NPI Number | 1568853844
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Entity Type | Individual
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Provider Name | IFFAT SHAHEEN MD
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Gender | Female
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Dates
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Enumeration Date | 02/09/2015
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 525 TECHNOLOGY PARK STE 109
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City | LAKE MARY
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State | FL
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Zip | 32746-7107
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Country | US
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Telephone | 407-647-2346
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Fax | 407-647-5431
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Provider Business Mailing Address
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Address Line | 148 PRESTWICK GRANDE DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32124-3032
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Country | US
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Telephone | 601-883-5000
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 31779
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 35.139188
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME153944
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | ME153944
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License Number State | FL
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