Provider Demographics
NPI:1275785776
Name:SHAHINA JAVEED MD PA
Entity Type:Organization
Organization Name:SHAHINA JAVEED MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:KLEINSCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-934-5765
Mailing Address - Street 1:4904 MOOG RD
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34690-1857
Mailing Address - Country:US
Mailing Address - Phone:727-934-5765
Mailing Address - Fax:727-943-0486
Practice Address - Street 1:4904 MOOG RD
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34690-1857
Practice Address - Country:US
Practice Address - Phone:727-934-5765
Practice Address - Fax:727-943-0486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0070915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1457354474OtherINDIVIDUAL NPI
FL257277000Medicaid
FLG40239Medicare UPIN
FL32156AMedicare PIN