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General NPI Number Information
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NPI Number | 1922066604
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Entity Type | Individual
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Provider Name | SHAHRZAD J GREY MD
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Gender | Female
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 10/29/2019
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Provider Practice Location Address
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Address Line | 2600 LAKE LUCIEN DR STE 112
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City | MAITLAND
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State | FL
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Zip | 32751
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Country | US
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Telephone | 321-207-9029
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Fax | 844-410-7960
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Provider Business Mailing Address
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Address Line | 2600 LAKE LUCIEN DR STE 112
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City | MAITLAND
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State | FL
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Zip | 32751-7233
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Country | US
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Telephone | 321-207-9029
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Fax | 844-410-7960
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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 | ME 94626
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License Number State | FL
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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 | 060459
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License Number State | GA
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