Provider Demographics
NPI:1679579783
Name:TAWWAB, SHAKEELA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHAKEELA
Middle Name:
Last Name:TAWWAB
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:PO BOX 5668
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32728-5668
Mailing Address - Country:US
Mailing Address - Phone:386-574-5565
Mailing Address - Fax:386-574-5811
Practice Address - Street 1:780 DELTONA BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7128
Practice Address - Country:US
Practice Address - Phone:386-574-5565
Practice Address - Fax:386-574-5811
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045362207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL592864076OtherTAX ID
FL11947Medicaid
FL64536Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID
FL11947Medicaid