Provider Demographics
NPI:1124090501
Name:SHAMA, STANLEY S (DPM)
Entity type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:S
Last Name:SHAMA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BULLARD PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617
Mailing Address - Country:US
Mailing Address - Phone:813-985-2811
Mailing Address - Fax:813-985-3045
Practice Address - Street 1:232 BULLARD PKWY
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-5512
Practice Address - Country:US
Practice Address - Phone:813-985-2811
Practice Address - Fax:813-985-3045
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1469207XX0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL058732000Medicaid
FL058732000Medicaid
87783Medicare ID - Type Unspecified