Provider Demographics
NPI:1538194402
Name:ISLAM, SHEHLA PESHIMAM (MD)
Entity type:Individual
Prefix:DR
First Name:SHEHLA
Middle Name:PESHIMAM
Last Name:ISLAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHEHLA
Other - Middle Name:MUBASHIR
Other - Last Name:PESHIMAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-392-4058
Mailing Address - Fax:352-392-6481
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-4058
Practice Address - Fax:352-392-6481
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS18234207RI0200X
FLME98378207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277982000Medicaid
MS02938388Medicaid
MS02938388Medicaid
AD576ZMedicare PIN
FL277982000Medicaid