1366778177 NPI number — DR. SHALOMIM YAHOSHUA HALAHAWI NMD DPH DFM D.TCM

Table of content: DR. SHALOMIM YAHOSHUA HALAHAWI NMD DPH DFM D.TCM (NPI 1366778177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366778177 NPI number — DR. SHALOMIM YAHOSHUA HALAHAWI NMD DPH DFM D.TCM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALAHAWI
Provider First Name:
SHALOMIM
Provider Middle Name:
YAHOSHUA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
NMD DPH DFM D.TCM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366778177
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1080 CYPRESS PKWY
Provider Second Line Business Mailing Address:
1108
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34759-3328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-909-4422
Provider Business Mailing Address Fax Number:
866-357-6267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4827 OLD NATIONAL HWY # 10016
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE PARK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30337-6234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-909-4422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP1600X , with the licence number:  012710311976-PCFL , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP1600X , with the licence number: LIC NO.10311976LPM , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133NN1002X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133NN1002X , with the licence number: NUT-012710311976FL , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133NN1002X , with the licence number: 10311976PNNT , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171100000X , with the licence number: MFS1102210797 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174H00000X , with the licence number: HE-04012016-103176 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174H00000X , with the licence number: 750127-1076PHE , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175F00000X , with the licence number: NAT#1000888 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175L00000X , with the licence number: 0127-HOM-1031976FLA , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 175L00000X , with the licence number: LIC.10311976P-MD , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2083P0901X , with the licence number: D-1130-M1PK , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364S00000X , with the licence number: SDCL/MIIM/ISD1208588 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: SDC-1208589 , registered in the state of ZZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LIC#10311976PMD . This is a "AMERICAN ASSOCIATION OF INTEGRATIVE & PASTORAL MEDICINE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 11D2003757 . This is a "GEORGIA DEPARTMENT OF COMMUNITY HEALTH CLIA REGISTRATION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".