Provider Demographics
NPI:1356306419
Name:SHUSTER, PAUL EMANUEL (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EMANUEL
Last Name:SHUSTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 VETERANS PARK DR STE 260
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-0494
Mailing Address - Country:US
Mailing Address - Phone:239-624-0570
Mailing Address - Fax:239-254-7959
Practice Address - Street 1:1845 VETERANS PARK DR STE 260
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-0494
Practice Address - Country:US
Practice Address - Phone:239-624-0570
Practice Address - Fax:239-254-7959
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00448192080A0000X
FLME138747208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD447891600Medicaid
FL101706900Medicaid
FL7NE26OtherBCBS