Provider Demographics
NPI:1164470811
Name:SHASHATY, RAYMOND JAMES (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:JAMES
Last Name:SHASHATY
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 1:1300 MICCOSUKEE RD
Mailing Address - Street 2:HOSPITALIST GROUP
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5054
Mailing Address - Country:US
Mailing Address - Phone:850-431-4996
Mailing Address - Fax:850-431-6315
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:HOSPITALIST GROUP
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-4996
Practice Address - Fax:850-431-6315
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68125208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL250759500Medicaid
FL31204ZMedicare PIN
FL250759500Medicaid