MEDICARE: WILSON SHULTERBRANDT HOLDINGS, LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1912701830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSON SHULTERBRANDT HOLDINGS, LLC

Provider Business Mailing Address
First Line	:	3316 CHARLES CT
Second Line	:
City	:	CHALMETTE
State	:	LA
Zip	:	70043-2615
Country	:	US
Telephone Number	:	985-517-4561
Fax Number	:

Provider Business Practice Location Address
First Line	:	13569 PANAMA CITY BEACH PKWY
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32407-2847
Country	:	US
Telephone Number	:	850-238-8563
Fax Number	:	850-238-8564

Authorized Official
Title or Position	:	CO-OWNER
Name	:	ANGEL SHULTERBRANDT
Credential	:
Telephone Number	:	985-517-4561

Provider Enumeration Date	:	04/01/2025
Last Update Date	:	04/01/2025

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