Provider Demographics
NPI:1194456665
Name:SHADY SALIB MD LLC
Entity type:Organization
Organization Name:SHADY SALIB MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHADY
Authorized Official - Middle Name:
Authorized Official - Last Name:SALIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-901-0429
Mailing Address - Street 1:3345 BURNS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4306
Mailing Address - Country:US
Mailing Address - Phone:561-622-7604
Mailing Address - Fax:561-622-7542
Practice Address - Street 1:3345 BURNS RD STE 204
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4306
Practice Address - Country:US
Practice Address - Phone:561-622-7604
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty