Provider Demographics
NPI:1285827139
Name:ABOVYAN, SHAGEN (MD)
Entity type:Individual
Prefix:
First Name:SHAGEN
Middle Name:
Last Name:ABOVYAN
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 1:1608 E COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-5719
Mailing Address - Country:US
Mailing Address - Phone:954-489-1345
Mailing Address - Fax:954-489-1052
Practice Address - Street 1:1608 EAST COMMERCIAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334
Practice Address - Country:US
Practice Address - Phone:954-489-1345
Practice Address - Fax:954-489-1052
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48709174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02774ZOtherMEDICARE ID
FLD20783Medicare UPIN
FLP00256799Medicare PIN