Provider Demographics
NPI:1275569899
Name:SHYDOHUB, ANTHONY ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:ANDREW
Last Name:SHYDOHUB
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 1:5441 N UNIVERSITY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33067-4640
Mailing Address - Country:US
Mailing Address - Phone:954-803-9002
Mailing Address - Fax:954-688-9118
Practice Address - Street 1:5441 N UNIVERSITY DR STE 101
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4640
Practice Address - Country:US
Practice Address - Phone:954-803-9002
Practice Address - Fax:954-933-2305
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00616802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370879900Medicaid
F36162Medicare UPIN
FL17782Medicare ID - Type Unspecified