Provider Demographics
NPI:1306355813
Name:SHOTOMIWA, RAHMAN A (PA)
Entity Type:Individual
Prefix:
First Name:RAHMAN
Middle Name:A
Last Name:SHOTOMIWA
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:18720 NW 27TH AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-3200
Mailing Address - Country:US
Mailing Address - Phone:786-382-5309
Mailing Address - Fax:
Practice Address - Street 1:302 NW 179TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2818
Practice Address - Country:US
Practice Address - Phone:954-442-8380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant