Provider Demographics
NPI:1619085610
Name:EUNUS, SHAHAB (MD)
Entity Type:Individual
Prefix:
First Name:SHAHAB
Middle Name:
Last Name:EUNUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHAHABUDDIN
Other - Middle Name:
Other - Last Name:MOHAMED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7960 SW 60TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-6408
Mailing Address - Country:US
Mailing Address - Phone:352-671-6741
Mailing Address - Fax:352-671-6742
Practice Address - Street 1:7960 SW 60TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34476-6408
Practice Address - Country:US
Practice Address - Phone:352-671-6741
Practice Address - Fax:352-671-6742
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
FLME96086208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL275780000Medicaid
FLJH468ZOtherPTAN