Provider Demographics
NPI:1942391099
Name:TAMTON, SHAMEEM (MD)
Entity Type:Individual
Prefix:
First Name:SHAMEEM
Middle Name:
Last Name:TAMTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 MADISON AVE W
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142
Mailing Address - Country:US
Mailing Address - Phone:239-658-3064
Mailing Address - Fax:239-658-3175
Practice Address - Street 1:1454 MADISON AVE W
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142
Practice Address - Country:US
Practice Address - Phone:239-658-3064
Practice Address - Fax:239-658-3175
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME54547208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLBT1602235Medicaid
FLBT1602235Medicaid
FLE58289Medicare UPIN