Provider Demographics
NPI:1710290721
Name:ELSHAZLY, MOHAMED BADRELDIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMED
Middle Name:BADRELDIN
Last Name:ELSHAZLY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:392 RINEHART RD STE 2080
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2541
Mailing Address - Country:US
Mailing Address - Phone:321-841-6444
Mailing Address - Fax:321-842-1955
Practice Address - Street 1:392 RINEHART RD STE 2080
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2541
Practice Address - Country:US
Practice Address - Phone:321-841-6444
Practice Address - Fax:321-842-1955
Is Sole Proprietor?:No
Enumeration Date:2010-07-19
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME164585207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL120068700Medicaid