Healthcare Provider Details

I. General information

NPI: 1164788832
Provider Name (Legal Business Name): JULIE SHANER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2012
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100286
GAINESVILLE FL
32610-0286
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-0301
  • Fax:
Mailing address:
  • Phone: 352-265-0535
  • Fax: 352-627-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberMD464339
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME145875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: