MEDICARE: MR. TIMOTHY RICHARD SHANER PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA3603	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730132408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TIMOTHY RICHARD SHANER PAC

Provider Business Mailing Address
First Line	:	151 SOUTHHALL LN STE 300
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-7172
Country	:	US
Telephone Number	:	407-875-2080
Fax Number	:	407-650-3455

Provider Business Practice Location Address
First Line	:	4132 WOODLANDS PKWY
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-3494
Country	:	US
Telephone Number	:	727-786-5100
Fax Number	:	727-789-8344

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/01/2019

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