Provider Demographics
NPI:1124099312
Name:USMANI, SHAISTA SHAMIM (MD)
Entity type:Individual
Prefix:DR
First Name:SHAISTA
Middle Name:SHAMIM
Last Name:USMANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 BOREN DR STE A
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2966
Mailing Address - Country:US
Mailing Address - Phone:407-395-2037
Mailing Address - Fax:407-395-2038
Practice Address - Street 1:1551 BOREN DR
Practice Address - Street 2:SUITE # A
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2966
Practice Address - Country:US
Practice Address - Phone:407-877-8300
Practice Address - Fax:407-877-8841
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62079208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375324700Medicaid
FL375324700Medicaid