Basic Information
| Provider Information | |||||||||
| NPI: | 1336362706 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MESGHALI MORALES | ||||||||
| FirstName: | SHEEBA | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MESGHALI | ||||||||
| OtherFirstName: | SHEEBA | ||||||||
| OtherMiddleName: | F | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1370 E VENICE AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342859082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414800500 | ||||||||
| FaxNumber: | 9414809322 | ||||||||
| Practice Location | |||||||||
| Address1: | 1370 E VENICE AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | VENICE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342859082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9414800500 | ||||||||
| FaxNumber: | 9414809322 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 05/13/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME99732 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | ME99732 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | P00649414 | 01 | FL | MEDICARE RAILROAD | OTHER | 07648 | 01 | FL | BCBS | OTHER |