Healthcare Provider Details

I. General information

NPI: 1285034165
Provider Name (Legal Business Name): MICHAEL SHANABERGER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 08/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9331 TAMIAMI TRL N STE 1
NAPLES FL
34108-2486
US

IV. Provider business mailing address

9331 TAMIAMI TRL N STE 1
NAPLES FL
34108-2486
US

V. Phone/Fax

Practice location:
  • Phone: 239-514-4014
  • Fax:
Mailing address:
  • Phone: 239-514-4014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAS 4962
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: