Basic Information
| Provider Information | |||||||||
| NPI: | 1306940887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHASHA | ||||||||
| FirstName: | ITZHAK | ||||||||
| MiddleName: | I | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 TAMPA GENERAL CIR | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138447000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1201 N OLIVE AVE | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334013515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616554334 | ||||||||
| FaxNumber: | 5616559449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2006 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | ME0044363 | FL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 4395 | 01 | FL | DIMENSION | OTHER | 1999249 | 01 | FL | CIGNA | OTHER | 1078157 | 01 | FL | WELLCARE | OTHER | P01607923 | 01 | FL | RR MEDICARE | OTHER | 61379 | 01 | FL | BCBS | OTHER | 4008202 | 01 | FL | AETNA | OTHER | 069346400 | 05 | FL | MEDICAID | 217581 | 01 | FL | AVMED | OTHER |