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NPI Code Detail

MEDICARE: OMAR SHUAYB

MEDICARE: OMAR SHUAYB
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
11223G0001XGeneral Practice DentistryDN17388FL

General Provider Information

NPI Number : 1710048426
Entity Type Code : Individual
Provider Name (Legal Business Name) : OMAR SHUAYB
Provider Business Mailing Address
First Line : 1770 N WICKHAM RD
Second Line :
City : MELBOURNE
State : FL
Zip : 32935-8122
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 11152 SPRING HILL DR
Second Line :
City : SPRING HILL
State : FL
Zip : 34609-4648
Country : US
Telephone Number : 352-688-2212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2006
Last Update Date : 07/08/2007

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Directions to “ OMAR SHUAYB ” Practice Location

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