Provider Demographics
NPI:1073264347
Name:SHAHLAMIAN, MEGAN LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:LEIGH
Last Name:SHAHLAMIAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2400 N COURTENAY PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-4127
Mailing Address - Country:US
Mailing Address - Phone:321-985-9097
Mailing Address - Fax:
Practice Address - Street 1:2400 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4127
Practice Address - Country:US
Practice Address - Phone:321-985-9097
Practice Address - Fax:321-301-4869
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11017204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine