Provider Demographics
NPI:1982829628
Name:SHUSTER, ANNA DUBROVICH (DO)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:DUBROVICH
Last Name:SHUSTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12730 NEW BRITTANY BLVD STE 602
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4690
Mailing Address - Country:US
Mailing Address - Phone:239-275-5522
Mailing Address - Fax:239-275-4464
Practice Address - Street 1:1255 VISCAYA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3290
Practice Address - Country:US
Practice Address - Phone:239-574-1988
Practice Address - Fax:239-574-1435
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101015926207Q00000X
FLOS10810207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001689100Medicaid
FL146WCOtherBCBS OF FLORIDA
FL001689100Medicaid