Provider Demographics
NPI:1972690329
Name:SHULMAN, ALISSA MARIE (MD)
Entity Type:Individual
Prefix:
First Name:ALISSA
Middle Name:MARIE
Last Name:SHULMAN
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 1:1950 ARLINGTON STREET
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3508
Mailing Address - Country:US
Mailing Address - Phone:941-366-5476
Mailing Address - Fax:941-866-7388
Practice Address - Street 1:1950 ARLINGTON ST
Practice Address - Street 2:SUITE 112
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3507
Practice Address - Country:US
Practice Address - Phone:941-366-5476
Practice Address - Fax:941-866-7388
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103128208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BI646ZOtherMEDICARE PTAN
FL000581900Medicaid
P00718900OtherMEDICARE RAILROAD PTAN
BI646ZOtherMEDICARE PTAN