Provider Demographics
NPI:1366778177
Name:HALAHAWI, SHALOMIM YAHOSHUA (NMD DPH DFM DTCM)
Entity type:Individual
Prefix:DR
First Name:SHALOMIM
Middle Name:YAHOSHUA
Last Name:HALAHAWI
Suffix:
Gender:M
Credentials:NMD DPH DFM DTCM
Other - Prefix:
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Mailing Address - Street 1:1080 CYPRESS PKWY
Mailing Address - Street 2:1108
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-3328
Mailing Address - Country:US
Mailing Address - Phone:678-909-4422
Mailing Address - Fax:866-357-6267
Practice Address - Street 1:4827 OLD NATIONAL HWY # 10016
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30337-6234
Practice Address - Country:US
Practice Address - Phone:678-909-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL012710311976-PCFL101YP1600X
GALIC NO.10311976LPM101YP1600X
GA133NN1002X
FLNUT-012710311976FL133NN1002X
ZZ10311976PNNT133NN1002X
ZZMFS1102210797171100000X
FLHE-04012016-103176174H00000X
ZZ750127-1076PHE174H00000X
DCNAT#1000888175F00000X
FL0127-HOM-1031976FLA175L00000X
GALIC.10311976P-MD175L00000X
ZZD-1130-M1PK2083P0901X
ZZSDCL/MIIM/ISD1208588364S00000X
ZZSDC-1208589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education
No171100000XOther Service ProvidersAcupuncturist
No174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath
No175L00000XOther Service ProvidersHomeopath
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GALIC#10311976PMDOtherAMERICAN ASSOCIATION OF INTEGRATIVE & PASTORAL MEDICINE
GA11D2003757OtherGEORGIA DEPARTMENT OF COMMUNITY HEALTH CLIA REGISTRATION
FL10311976PMD-FLOtherAMERICAN ASSOCIATION OF INTEGRATIVE & PASTORAL MEDICINE