Provider Demographics
NPI:1972662286
Name:ANTHONY SHYDOHUB MD PA
Entity Type:Organization
Organization Name:ANTHONY SHYDOHUB MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:SHYDOHUB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-382-6088
Mailing Address - Street 1:4850 SUN N LAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2110
Mailing Address - Country:US
Mailing Address - Phone:863-382-6088
Mailing Address - Fax:863-382-9424
Practice Address - Street 1:4850 SUN N LAKE BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2110
Practice Address - Country:US
Practice Address - Phone:863-382-6088
Practice Address - Fax:863-382-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00616802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL17782Medicare ID - Type UnspecifiedMEDICARE NUMBER
FLF36162Medicare UPIN