MEDICARE: HALIFAX PATHOLOGY ASSOCIATES 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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician

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	:	1124711221
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALIFAX PATHOLOGY ASSOCIATES PA

Provider Business Mailing Address
First Line	:	PO BOX 935088
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-5088
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 E HALIFAX CROSSING BLVD
Second Line	:
City	:	DELTONA
State	:	FL
Zip	:	32725-2911
Country	:	US
Telephone Number	:	386-425-4139
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, AUTHORIZED OFFICIAL
Name	:	LORA J. SHEHI
Credential	:
Telephone Number	:	386-425-4139

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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