Provider Demographics
NPI:1154529642
Name:SHAMMAS, LILIA RASHITOVNA (MD)
Entity type:Individual
Prefix:
First Name:LILIA
Middle Name:RASHITOVNA
Last Name:SHAMMAS
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 1:1990 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9792
Mailing Address - Country:US
Mailing Address - Phone:352-527-6888
Mailing Address - Fax:352-527-8818
Practice Address - Street 1:1990 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9792
Practice Address - Country:US
Practice Address - Phone:352-527-6888
Practice Address - Fax:352-527-8818
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN 11788208000000X
FLME108609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002888100Medicaid