Provider Demographics
NPI:1568436731
Name:SHAMSIN, AHMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMAD
Middle Name:
Last Name:SHAMSIN
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 1:731 DUNLAWTON AVE
Mailing Address - Street 2:SUITES 101 & 102
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4236
Mailing Address - Country:US
Mailing Address - Phone:386-767-9585
Mailing Address - Fax:386-767-9769
Practice Address - Street 1:731 DUNLAWTON AVE
Practice Address - Street 2:SUITES 101 & 102
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4236
Practice Address - Country:US
Practice Address - Phone:386-767-9585
Practice Address - Fax:386-767-9769
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90030207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269974500Medicaid
FLME90030OtherMEDICAL LICENSE
FL46138VMedicare PIN
FLI16187Medicare UPIN