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General NPI Number Information
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NPI Number | 1770865917
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Entity Type | Organization
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Legal Business Name | IRA FIALKO DO PA
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Dates
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Enumeration Date | 09/14/2011
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 6171 W GULF TO LAKE HWY
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City | CRYSTAL RIVER
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State | FL
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Zip | 34429-2679
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Country | US
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Telephone | 352-563-0220
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Fax | 352-563-0706
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Provider Business Mailing Address
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Address Line | 7960 SW 60TH AVE STE 100
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City | OCALA
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State | FL
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Zip | 34476-6409
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Country | US
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Telephone | 352-671-6741
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Fax | 352-671-6742
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Authorized Official
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Title or Position | OWNER
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Name | SHAHAB EUNUS
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Credential | MD
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Telephone | 352-671-6741
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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