MEDICARE: SHEYAR WALA AMIN MD

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	2084V0102X	Vascular Neurology Physician	ME141101	FL
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208M00000X	Hospitalist Physician	ME141101	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	N6QM3	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720511769
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEYAR WALA AMIN MD

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:	813-821-8038
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4544
Country	:	US
Telephone Number	:	813-821-8034
Fax Number	:

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	12/07/2025

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