Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | ME94436 | FL |
N | 208D00000X | General Practice Physician | ME94436 | FL |
NPI | 1538271952 |
---|---|
Provider Name | Shama Hussain |
First Address | Olrando, FL 32812 |
Second Address | Olrando, FL 32812 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 17/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
274097400 | (05) | FL |
H40666 | (02) | FL |