Healthcare Provider Details

I. General information

NPI: 1033099775
Provider Name (Legal Business Name): AXIS MULTISPECIALTY GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 NW 56TH TER STE B
GAINESVILLE FL
32605-6401
US

IV. Provider business mailing address

817 NW 56TH TER STE B
GAINESVILLE FL
32605-6401
US

V. Phone/Fax

Practice location:
  • Phone: 352-234-3050
  • Fax: 702-977-1496
Mailing address:
  • Phone: 352-234-3050
  • Fax: 702-977-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: KAYLA SHANKS
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 725-235-7239