Provider Demographics
NPI:1538125786
Name:BAHN, SHIELA A (MD)
Entity Type:Individual
Prefix:
First Name:SHIELA
Middle Name:A
Last Name:BAHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 S WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3546
Mailing Address - Country:US
Mailing Address - Phone:407-905-8827
Mailing Address - Fax:407-886-1229
Practice Address - Street 1:225 E 7TH ST
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5327
Practice Address - Country:US
Practice Address - Phone:407-905-8827
Practice Address - Fax:407-886-1229
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81822207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262246700Medicaid
FL01085OtherBCBS
FL262246700Medicaid
FLG39475Medicare UPIN
FL01085ZMedicare PIN