Provider Demographics
NPI:1164498465
Name:MASANI, SHAMA (MD)
Entity Type:Individual
Prefix:
First Name:SHAMA
Middle Name:
Last Name:MASANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5010 MILE STRETCH DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-4431
Mailing Address - Country:US
Mailing Address - Phone:727-943-9080
Mailing Address - Fax:727-937-8411
Practice Address - Street 1:5010 MILE STRETCH DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34690-4431
Practice Address - Country:US
Practice Address - Phone:727-943-9080
Practice Address - Fax:727-937-8411
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265249800Medicaid
FL51474Medicare ID - Type Unspecified