Provider Demographics
NPI:1245218296
Name:SALIB, SHADY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHADY
Middle Name:
Last Name:SALIB
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 1:3345 BURNS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4324
Mailing Address - Country:US
Mailing Address - Phone:561-622-7604
Mailing Address - Fax:561-622-7542
Practice Address - Street 1:3345 BURNS RD STE 204
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4324
Practice Address - Country:US
Practice Address - Phone:561-622-7604
Practice Address - Fax:561-622-7542
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL101964208M00000X
FLME101964207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00724545OtherRAILROAD MEDICARE
FLP00724545OtherRAILROAD MEDICARE
I43943Medicare UPIN
NV101333Medicare ID - Type Unspecified
FLBT094ZMedicare PIN