Healthcare Provider Details

I. General information

NPI: 1407105620
Provider Name (Legal Business Name): SHANEDELLE NORFORD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 S 35TH ST
FORT PIERCE FL
34981
US

IV. Provider business mailing address

2500 S 35TH ST
FORT PIERCE FL
34981-5573
US

V. Phone/Fax

Practice location:
  • Phone: 340-344-6542
  • Fax:
Mailing address:
  • Phone: 340-344-6542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number17579
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number17579
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberME130661
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: