Provider Demographics
NPI:1447491824
Name:TABBA, SHADI
Entity type:Individual
Prefix:DR
First Name:SHADI
Middle Name:
Last Name:TABBA
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SHADI
Other - Middle Name:
Other - Last Name:TABBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14357 WABASSO LOOP
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5797
Mailing Address - Country:US
Mailing Address - Phone:813-679-4487
Mailing Address - Fax:
Practice Address - Street 1:60 W GORE ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1141
Practice Address - Country:US
Practice Address - Phone:813-679-4487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1520672080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology