Provider Demographics
NPI:1295602159
Name:SHALAM RUSLAN ORLANDO SOUTHWEST LLC
Entity type:Organization
Organization Name:SHALAM RUSLAN ORLANDO SOUTHWEST LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-351-7500
Mailing Address - Street 1:13848 TILDEN RD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5326
Mailing Address - Country:US
Mailing Address - Phone:321-351-7500
Mailing Address - Fax:
Practice Address - Street 1:13848 TILDEN RD
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-5326
Practice Address - Country:US
Practice Address - Phone:321-351-7500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-23
Last Update Date:2025-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty