Provider Demographics
NPI:1669518320
Name:SHUKUR, AYAD (MD)
Entity type:Individual
Prefix:
First Name:AYAD
Middle Name:
Last Name:SHUKUR
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:PO BOX 780547
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32878-0547
Mailing Address - Country:US
Mailing Address - Phone:407-482-5588
Mailing Address - Fax:407-358-5084
Practice Address - Street 1:7975 LAKE UNDERHILL RD STE 240
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-8208
Practice Address - Country:US
Practice Address - Phone:407-265-2042
Practice Address - Fax:407-289-5263
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL93764207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200064130AMedicaid
FL000283500Medicaid
OK200064130AMedicaid
FL000283500Medicaid
FLBJ007ZMedicare PIN
OK248530815Medicare ID - Type Unspecified