Provider Demographics
NPI:1922025782
Name:FLORIDA COASTAL CARDIOLOGY P A
Entity Type:Organization
Organization Name:FLORIDA COASTAL CARDIOLOGY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHEZAD
Authorized Official - Middle Name:
Authorized Official - Last Name:SANAULLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-653-4134
Mailing Address - Street 1:7100 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-7355
Mailing Address - Country:US
Mailing Address - Phone:954-967-0107
Mailing Address - Fax:954-967-0109
Practice Address - Street 1:74 16TH ST
Practice Address - Street 2:
Practice Address - City:APALACHICOLA
Practice Address - State:FL
Practice Address - Zip Code:32320-2064
Practice Address - Country:US
Practice Address - Phone:850-653-4134
Practice Address - Fax:850-653-4135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6164Medicare PIN