Provider Demographics
NPI:1306940887
Name:SHASHA, ITZHAK I (MD)
Entity type:Individual
Prefix:
First Name:ITZHAK
Middle Name:I
Last Name:SHASHA
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 1:1 TAMPA GENERAL CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3571
Mailing Address - Country:US
Mailing Address - Phone:813-844-7000
Mailing Address - Fax:
Practice Address - Street 1:1201 N OLIVE AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3515
Practice Address - Country:US
Practice Address - Phone:561-655-4334
Practice Address - Fax:561-655-9449
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0044363208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4395OtherDIMENSION
FL1999249OtherCIGNA
FL1078157OtherWELLCARE
FLP01607923OtherRR MEDICARE
FL61379OtherBCBS
FL4008202OtherAETNA
FL069346400Medicaid
FL217581OtherAVMED
FL4395OtherDIMENSION
FLP01607923OtherRR MEDICARE
FL217581OtherAVMED