Basic Information
| Provider Information | |||||||||
| NPI: | 1710932405 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ATLANTIC EAR NOSE & THROAT PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 953577 | ||||||||
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| City: | LAKE MARY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327953577 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867749880 | ||||||||
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| Practice Location | |||||||||
| Address1: | 963 TOWN CENTER DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ORANGE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327638254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867749880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 09/29/2011 | ||||||||
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| AuthorizedOfficialLastName: | SHAH | ||||||||
| AuthorizedOfficialFirstName: | DEVANG | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3867749880 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.