Provider Demographics
NPI:1679870935
Name:SOBHY SHEHATA, M.D., P.A.
Entity Type:Organization
Organization Name:SOBHY SHEHATA, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SOBHY
Authorized Official - Middle Name:DAOUD
Authorized Official - Last Name:SHEHATA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-787-4595
Mailing Address - Street 1:34645 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-2152
Mailing Address - Country:US
Mailing Address - Phone:727-787-4595
Mailing Address - Fax:727-784-7896
Practice Address - Street 1:34645 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2152
Practice Address - Country:US
Practice Address - Phone:727-787-4595
Practice Address - Fax:727-784-7896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-23
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD79328Medicare UPIN