Healthcare Provider Details

I. General information

NPI: 1720661291
Provider Name (Legal Business Name): DR. SHANNON RAMIREZ, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 10/31/2024
Certification Date: 10/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 S STATE ROAD 434
ALTAMONTE SPRINGS FL
32714-3502
US

IV. Provider business mailing address

1070 MONTGOMERY RD # 401
ALTAMONTE SPRINGS FL
32714-7420
US

V. Phone/Fax

Practice location:
  • Phone: 407-587-8600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. SHANNON RAMIREZ
Title or Position: OWNER
Credential: DO
Phone: 678-889-0881