Provider Demographics
NPI:1932474368
Name:SHAKEELA TAWWAB MD PA
Entity Type:Organization
Organization Name:SHAKEELA TAWWAB MD PA
Other - Org Name:SHAKEELA TAWWAB MD PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAKEELA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAWWAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-574-5565
Mailing Address - Street 1:780 DELTONA BLVD
Mailing Address - Street 2:#104
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-7128
Mailing Address - Country:US
Mailing Address - Phone:386-574-5565
Mailing Address - Fax:386-574-8567
Practice Address - Street 1:780 DELTONA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-7128
Practice Address - Country:US
Practice Address - Phone:386-574-5565
Practice Address - Fax:386-574-8567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL036053800Medicaid
FL036053800Medicaid