# SHALOM MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619793452
- **Authorized official:** SURISADAY RONES (OWNER)
- **Authorized official phone:** (786) 374-9928

## Contact information

- **Practice address:** 8302 NW 103RD ST STE 205, HIALEAH GARDENS, FL 33016-4698
- **Practice address phone:** (786) 651-2442
- **Mailing address:** 8302 NW 103RD ST STE 205, HIALEAH GARDENS, FL 33016-4698
- **Mailing address phone:** (786) 651-2442

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103K00000X | Behavior Analyst | — | NULL | — |
| 103K00000X | Behavior Analyst | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 11/26/2024
- **Last updated:** 07/28/2025