Provider Demographics
NPI:1417108895
Name:SHENASSA, DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:SHENASSA
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 1:1608 TOWN CENTER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3639
Mailing Address - Country:US
Mailing Address - Phone:954-349-2345
Mailing Address - Fax:954-641-1086
Practice Address - Street 1:1600 TOWN CENTER CIR STE C
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326
Practice Address - Country:US
Practice Address - Phone:954-389-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105233207XS0106X, 207XS0106X
CAA102331207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002876700OtherGROUP MEDICAID
FL002462700Medicaid
K0493OtherGROUP MEDICARE PTAN
FL002876700OtherGROUP MEDICAID
K0493OtherGROUP MEDICARE PTAN
DD524ZMedicare PIN