Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | ME104963 | FL |
NPI | 1265608806 |
---|---|
Provider Name | Fadi Abu Shahin |
First Address | Fort Myers, FL 33907-1412 |
Second Address | Fort Myers, FL 33905-7809 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2008 |
Last Update Date | 18/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001279900 | MEDICAID (01) | FL |
1002617 | WELLCARE-MEDICARE AND MEDICAID (01) | FL |
145ZM | BCBS FL (01) | FL |
3377068 | CIGNA (01) | FL |