Provider Demographics
NPI:1578346391
Name:SHUAYB, FATIMA (DMD)
Entity Type:Individual
Prefix:
First Name:FATIMA
Middle Name:
Last Name:SHUAYB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17665 BELLAVISTA LOOP # 1420
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-5658
Mailing Address - Country:US
Mailing Address - Phone:352-442-1818
Mailing Address - Fax:
Practice Address - Street 1:12900 CORTEZ BLVD STE 201
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7808
Practice Address - Country:US
Practice Address - Phone:352-397-9689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN282221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice