Basic Information
| Provider Information | |||||||||
| NPI: | 1356306419 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHUSTER | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | EMANUEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1845 VETERANS PARK DR STE 260 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341090494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396240570 | ||||||||
| FaxNumber: | 2392547959 | ||||||||
| Practice Location | |||||||||
| Address1: | 1845 VETERANS PARK DR STE 260 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341090494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396240570 | ||||||||
| FaxNumber: | 2392547959 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 04/29/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | D0044819 | MD | N | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine | 208000000X | ME138747 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 447891600 | 05 | MD | MEDICAID | 101706900 | 05 | FL | MEDICAID | 7NE26 | 01 | FL | BCBS | OTHER |