Provider Demographics
NPI:1619396397
Name:SHATIL, BEN SIMON (DO)
Entity type:Individual
Prefix:
First Name:BEN
Middle Name:SIMON
Last Name:SHATIL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 CONNALLY ST SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-3036
Mailing Address - Country:US
Mailing Address - Phone:954-347-2396
Mailing Address - Fax:
Practice Address - Street 1:3314 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-5554
Practice Address - Country:US
Practice Address - Phone:755-215-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-10
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83639207L00000X
WI101995-875207L00000X
NY295817207L00000X
FLOS16542207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology