Provider Demographics
NPI:1760456677
Name:SHAMOUN, DANY (MD)
Entity Type:Individual
Prefix:
First Name:DANY
Middle Name:
Last Name:SHAMOUN
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 1:2884 WELLNESS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8427
Mailing Address - Country:US
Mailing Address - Phone:386-668-2221
Mailing Address - Fax:386-668-2228
Practice Address - Street 1:2884 WELLNESS AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8427
Practice Address - Country:US
Practice Address - Phone:386-668-2221
Practice Address - Fax:386-668-2228
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5319207RG0100X
FLME140883207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN440R1SHOtherBLUE CROSS
MN440R1SHOtherCC SYSTEMS/ BLUE PLUS
SD2900336OtherMEDICA
SD769171040477OtherPREFERRED ONE
SDHP40574OtherHEALTHPARTNERS
SD36776OtherSANFORD HEALTH PLAN
NE46022474338Medicaid
SD2048379OtherARAZ/ AMERICA'S PPO
SD5319OtherDAKOTACARE
IA1234161Medicaid
SD233250OtherMIDLANDS CHOICE
MN260490600Medicaid
SD4995448OtherBLUE CROSS
SD57105B007OtherWPS TRICARE
SDP00177572OtherRR MEDICARE
MN92411422906OtherPRIMEWEST
SD2900336OtherMEDICA
MN92411422906OtherPRIMEWEST
IA1234161Medicaid