Provider Demographics
NPI:1316037096
Name:SHAKAR, SIMON FARID (MD)
Entity type:Individual
Prefix:MR
First Name:SIMON
Middle Name:FARID
Last Name:SHAKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 N. ORANGE AVENUE
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-303-3608
Mailing Address - Fax:407-303-0680
Practice Address - Street 1:2415 N. ORANGE AVENUE
Practice Address - Street 2:SUITE 700
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-303-3608
Practice Address - Fax:407-303-0680
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO34012207RC0000X
FLME121217207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55222781Medicaid
CO55222781Medicaid