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General NPI Number Information
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NPI Number | 1770781502
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Entity Type | Individual
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Provider Name | GARY SHIENBAUM M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/03/2007
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 7261 SHERIDAN ST STE 320
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City | HOLLYWOOD
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State | FL
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Zip | 33024-2708
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Country | US
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Telephone | 954-372-7220
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Fax | 954-613-9522
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Provider Business Mailing Address
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Address Line | 7261 SHERIDAN ST STE 320
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City | HOLLYWOOD
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State | FL
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Zip | 33024-2725
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Country | US
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Telephone | 954-372-7220
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Fax | 954-613-9522
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME109057
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | ME109057
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License Number State | FL
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