Provider Demographics
NPI:1659514511
Name:MILLER, SHAMAAL M (MD)
Entity Type:Individual
Prefix:
First Name:SHAMAAL
Middle Name:M
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SHAMAAL
Other - Middle Name:MAURI
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:111 N 12TH ST
Mailing Address - Street 2:APT. 1816
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3661
Mailing Address - Country:US
Mailing Address - Phone:912-257-6419
Mailing Address - Fax:
Practice Address - Street 1:111 N 12TH ST
Practice Address - Street 2:APT. 1816
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3661
Practice Address - Country:US
Practice Address - Phone:912-257-6419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME122651207L00000X
PAMD448084207L00000X
NJ25MA09360700207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology