Provider Demographics
NPI:1366823775
Name:SHAATH, TAREK S (MD)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:S
Last Name:SHAATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:697 OAK HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-1838
Mailing Address - Country:US
Mailing Address - Phone:785-760-6740
Mailing Address - Fax:
Practice Address - Street 1:1040 LAKE SUMTER LNDG
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-2697
Practice Address - Country:US
Practice Address - Phone:352-218-3211
Practice Address - Fax:877-699-3709
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-11
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME136133207ND0900X, 207NS0135X, 207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology