Provider Demographics
NPI:1275521890
Name:SHAKFEH, SAMIR M (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMIR
Middle Name:M
Last Name:SHAKFEH
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 1:221 MARINER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-5692
Mailing Address - Country:US
Mailing Address - Phone:352-666-0544
Mailing Address - Fax:352-688-0464
Practice Address - Street 1:221 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5692
Practice Address - Country:US
Practice Address - Phone:352-666-0544
Practice Address - Fax:352-688-0464
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62854207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371257500Medicaid
FL371257500Medicaid
FL18062AMedicare ID - Type Unspecified