Provider Demographics
NPI:1417247792
Name:SHAMSEDDINE, KHADIJAH FATIMAH (MD)
Entity Type:Individual
Prefix:DR
First Name:KHADIJAH
Middle Name:FATIMAH
Last Name:SHAMSEDDINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9730 COMMERCE CENTER CT
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-3615
Mailing Address - Country:US
Mailing Address - Phone:239-590-9190
Mailing Address - Fax:239-989-0166
Practice Address - Street 1:9730 COMMERCE CENTER CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3615
Practice Address - Country:US
Practice Address - Phone:239-590-9190
Practice Address - Fax:239-989-0166
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1180662084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology