Provider Demographics
NPI:1952923351
Name:SHUAIB, HAADI (MD)
Entity Type:Individual
Prefix:
First Name:HAADI
Middle Name:
Last Name:SHUAIB
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 1:13067 TELECOM PKWY N
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33637
Mailing Address - Country:US
Mailing Address - Phone:813-773-6658
Mailing Address - Fax:786-868-0012
Practice Address - Street 1:13067 TELECOM PKWY N
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33637
Practice Address - Country:US
Practice Address - Phone:813-773-6658
Practice Address - Fax:786-868-0012
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2023-11-28
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2023-08-15
Provider Licenses
StateLicense IDTaxonomies
244202390200000X
FLME163437207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program