Provider Demographics
NPI:1154969335
Name:HMEIDAN, SHAHED (PA)
Entity type:Individual
Prefix:
First Name:SHAHED
Middle Name:
Last Name:HMEIDAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2624 CLEMENTON PARK CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-6160
Mailing Address - Country:US
Mailing Address - Phone:321-732-1769
Mailing Address - Fax:
Practice Address - Street 1:2624 CLEMENTON PARK CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-6160
Practice Address - Country:US
Practice Address - Phone:321-732-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-18
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112840363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant