Provider Demographics
NPI:1285610188
Name:SAMY, SHAHID (MD)
Entity type:Individual
Prefix:DR
First Name:SHAHID
Middle Name:
Last Name:SAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1588 CITRUS MEDICAL COURT
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4547
Mailing Address - Country:US
Mailing Address - Phone:407-733-0275
Mailing Address - Fax:407-435-9671
Practice Address - Street 1:1588 CITRUS MEDICAL COURT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4547
Practice Address - Country:US
Practice Address - Phone:407-733-0275
Practice Address - Fax:407-435-9671
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83070207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263497000Medicaid
FL263497000Medicaid
FLE5857AMedicare PIN