Provider Demographics
NPI:1649971722
Name:SHAKOOR, KHALID (DOM)
Entity type:Individual
Prefix:DR
First Name:KHALID
Middle Name:
Last Name:SHAKOOR
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2610 NW 43RD ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6677
Mailing Address - Country:US
Mailing Address - Phone:352-448-5836
Mailing Address - Fax:352-448-7789
Practice Address - Street 1:2610 NW 43RD ST STE 1A
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-6677
Practice Address - Country:US
Practice Address - Phone:352-448-5836
Practice Address - Fax:352-448-7789
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist