Provider Demographics
NPI:1184507386
Name:BUBISHATE, SALEH A S A KH (MD)
Entity type:Individual
Prefix:DR
First Name:SALEH
Middle Name:A S A KH
Last Name:BUBISHATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 LUNAR LN APT 414
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-1727
Mailing Address - Country:US
Mailing Address - Phone:321-559-9085
Mailing Address - Fax:
Practice Address - Street 1:380 CELEBRATION PL STE 401
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-4606
Practice Address - Country:US
Practice Address - Phone:321-559-9085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43080390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program