Provider Demographics
NPI:1164580593
Name:SUFIAN, SHEKEEB
Entity Type:Individual
Prefix:DR
First Name:SHEKEEB
Middle Name:
Last Name:SUFIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13581 HERITAGE DR
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-3449
Mailing Address - Country:US
Mailing Address - Phone:727-393-0143
Mailing Address - Fax:
Practice Address - Street 1:13581 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-3449
Practice Address - Country:US
Practice Address - Phone:727-393-0143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-13596208600000X
NC35054208600000X
VA0101239201208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery