MEDICARE: DR. AHMAD SHAMSIN M.D.

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	207RC0000X	Cardiovascular Disease Physician	ME90030	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	ME90030	OTHER	FL	MEDICAL LICENSE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568436731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AHMAD SHAMSIN M.D.

Provider Business Mailing Address
First Line	:	731 DUNLAWTON AVE
Second Line	:	SUITES 101 & 102
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4236
Country	:	US
Telephone Number	:	386-767-9585
Fax Number	:	386-767-9769

Provider Business Practice Location Address
First Line	:	731 DUNLAWTON AVE
Second Line	:	SUITES 101 & 102
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4236
Country	:	US
Telephone Number	:	386-767-9585
Fax Number	:	386-767-9769

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	08/02/2013

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Directions to “ DR. AHMAD SHAMSIN M.D.” Practice Location

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