Provider Demographics
NPI:1992760128
Name:AMIN, SHIRLEY U F (MD)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:U F
Last Name:AMIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:AMIN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1500 SW 15TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-3308
Mailing Address - Country:US
Mailing Address - Phone:954-527-0747
Mailing Address - Fax:
Practice Address - Street 1:1600 S ANDREWS AVENUE
Practice Address - Street 2:BROWARD GENERAL MEDICAL CENTER
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316
Practice Address - Country:US
Practice Address - Phone:954-355-5589
Practice Address - Fax:954-355-4139
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036144207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370408400Medicaid
D63125Medicare UPIN
FL94123YMedicare ID - Type Unspecified