Provider Demographics
NPI:1689824286
Name:COLE, SHOLA A (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOLA
Middle Name:A
Last Name:COLE
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 1:100 W GRANT ST
Mailing Address - Street 2:#3085
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-3929
Mailing Address - Country:US
Mailing Address - Phone:718-757-9365
Mailing Address - Fax:
Practice Address - Street 1:100 W GRANT ST
Practice Address - Street 2:#3085
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-3929
Practice Address - Country:US
Practice Address - Phone:718-757-9365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0013625208600000X
390200000X
FLME124147390200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program