Healthcare Provider Details

I. General information

NPI: 1164497491
Provider Name (Legal Business Name): SHAUN JASON LIMON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11065 GATEWOOD DR # C-102
LAKEWOOD RANCH FL
34211-4944
US

IV. Provider business mailing address

11065 GATEWOOD DR STE C-102
LAKEWOOD RANCH FL
34211-4944
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-8639
  • Fax: 941-751-0976
Mailing address:
  • Phone: 941-756-6906
  • Fax: 941-751-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO2722
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: