Provider Demographics
NPI:1710948971
Name:SHEBANI, KHALED OMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KHALED
Middle Name:OMAR
Last Name:SHEBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SE MAGNOLIA EXT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4463
Mailing Address - Country:US
Mailing Address - Phone:352-620-2711
Mailing Address - Fax:352-620-2712
Practice Address - Street 1:1500 SE MAGNOLIA EXT
Practice Address - Street 2:SUITE 201
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4463
Practice Address - Country:US
Practice Address - Phone:352-620-2711
Practice Address - Fax:352-620-2712
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95263174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME95263OtherMEDICAL LICENSE