MEDICARE: RAFAT SHAFIK ISKANDER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9100077	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053332122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAFAT SHAFIK ISKANDER PA

Provider Business Mailing Address
First Line	:	400 CLYDE MORRIS BLVD
Second Line	:	STE A
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8171
Country	:	US
Telephone Number	:	386-677-0987
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 CLYDE MORRIS BLVD
Second Line	:	STE A
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-8171
Country	:	US
Telephone Number	:	386-677-0987
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	05/24/2012

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Directions to “ RAFAT SHAFIK ISKANDER PA” Practice Location

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