Provider Demographics
NPI:1770781502
Name:SHIENBAUM, GARY (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:SHIENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7261 SHERIDAN ST STE 320
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2725
Mailing Address - Country:US
Mailing Address - Phone:954-372-7220
Mailing Address - Fax:954-613-9522
Practice Address - Street 1:7261 SHERIDAN ST STE 320
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2708
Practice Address - Country:US
Practice Address - Phone:954-372-7220
Practice Address - Fax:954-613-9522
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109057207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist