MEDICARE: MR. STANLEY S SHAMA DPM

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	207XX0004X	Orthopaedic Foot and Ankle Surgery Physician	PO1469	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124090501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STANLEY S SHAMA DPM

Provider Business Mailing Address
First Line	:	232 BULLARD PKWY
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617
Country	:	US
Telephone Number	:	813-985-2811
Fax Number	:	813-985-3045

Provider Business Practice Location Address
First Line	:	232 BULLARD PKWY
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-5512
Country	:	US
Telephone Number	:	813-985-2811
Fax Number	:	813-985-3045

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

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	07/16/2010

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