Individual
DR. KAMBIZ KEVIN SHAMLOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1673 MASON AVE, SUITE# 305, DAYTONA BEACH, FL 32117-5515
(386) 274-7118
(386) 274-6173
Mailing address
1673 MASON AVE STE 305, DAYTONA BEACH, FL 32117-5516
(386) 274-7118
(386) 274-6173
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
ME63960
FL
2085B0100X
Body Imaging Physician
ME0063960
FL
2085N0700X
Neuroradiology Physician
ME0063960
FL
2085N0904X
Nuclear Radiology Physician
ME0063960
FL
2085P0229X
Pediatric Radiology Physician
ME0063960
FL
2085R0202X
Diagnostic Radiology Physician
109350
GA
2085R0202X
Diagnostic Radiology Physician
Primary
ME0063960
FL
2085R0203X
Therapeutic Radiology Physician
ME0063960
FL
2085R0204X
Vascular & Interventional Radiology Physician
ME0063960
FL
2085U0001X
Diagnostic Ultrasound Physician
ME0063960
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
375394800
—
FL
01
—
68718
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/11/2006
Last updated
04/07/2026
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