Provider Demographics
NPI:1427124049
Name:AHMED, SHAFAAT (MD)
Entity type:Individual
Prefix:DR
First Name:SHAFAAT
Middle Name:
Last Name:AHMED
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 1:1121 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:35117
Mailing Address - Country:US
Mailing Address - Phone:386-255-1461
Mailing Address - Fax:386-255-7509
Practice Address - Street 1:1121 MASON AVE
Practice Address - Street 2:DAYTONA BEACH FLORIDA
Practice Address - City:DAYTONA BCH
Practice Address - State:FL
Practice Address - Zip Code:35117
Practice Address - Country:US
Practice Address - Phone:386-255-1461
Practice Address - Fax:386-255-7509
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0011578207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
D57582Medicare UPIN
FL64188Medicare ID - Type Unspecified