Provider Demographics
NPI:1144343690
Name:SHAHUL HAMEED RIAZUDEEN MD PA
Entity type:Organization
Organization Name:SHAHUL HAMEED RIAZUDEEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHUL
Authorized Official - Middle Name:HAMEED
Authorized Official - Last Name:RIAZUDEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-633-1100
Mailing Address - Street 1:PO BOX 5849
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33571-5849
Mailing Address - Country:US
Mailing Address - Phone:813-633-1100
Mailing Address - Fax:813-633-1152
Practice Address - Street 1:16541 S US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-2032
Practice Address - Country:US
Practice Address - Phone:813-633-1100
Practice Address - Fax:813-633-1152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93264207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDG2737Medicare PIN
FLAE305Medicare PIN