Provider Demographics
NPI:1386744639
Name:FARUQUE, SHAHEEN (MD)
Entity type:Individual
Prefix:MRS
First Name:SHAHEEN
Middle Name:
Last Name:FARUQUE
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:239-599-2612
Practice Address - Street 1:2351 AARON ST
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-5305
Practice Address - Country:US
Practice Address - Phone:855-979-5700
Practice Address - Fax:855-979-5701
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME95171207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL56582OtherBC/BS
FL280098500Medicaid
FL56582OtherBC/BS
FLAD052YMedicare PIN
FLAD052Medicare PIN