MEDICARE: SHENIDA DESIR LLC

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	261QM2500X	Medical Specialty Clinic/Center

General Provider Information

NPI Number	:	1962093971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHENIDA DESIR LLC

Provider Business Mailing Address
First Line	:	3893 NW 73RD TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2147
Country	:	US
Telephone Number	:	954-918-9903
Fax Number	:

Provider Business Practice Location Address
First Line	:	3893 NW 73RD TER
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-2147
Country	:	US
Telephone Number	:	954-918-9903
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHENIDA DESIR
Credential	:	NP
Telephone Number	:	954-918-9903

Provider Enumeration Date	:	02/02/2021
Last Update Date	:	02/02/2021

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