Provider Demographics
NPI:1922041284
Name:SHUAYB, HUSAM E (MD)
Entity Type:Individual
Prefix:DR
First Name:HUSAM
Middle Name:E
Last Name:SHUAYB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11373 CORTEZ BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5414
Mailing Address - Country:US
Mailing Address - Phone:352-596-6264
Mailing Address - Fax:352-596-7550
Practice Address - Street 1:11373 CORTEZ BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5414
Practice Address - Country:US
Practice Address - Phone:352-596-6264
Practice Address - Fax:352-596-7550
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME038075207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL26037Medicare ID - Type Unspecified
FLD53434Medicare UPIN
FL065334900Medicare ID - Type Unspecified