Healthcare Provider Details

I. General information

NPI: 1407012503
Provider Name (Legal Business Name): STEVEN BARRY SHUKAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 07/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5070 SUNBURY CT
NAPLES FL
34104-4730
US

IV. Provider business mailing address

5070 SUNBURY CT
NAPLES FL
34104-4730
US

V. Phone/Fax

Practice location:
  • Phone: 239-877-1538
  • Fax:
Mailing address:
  • Phone: 239-877-1538
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA03339400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: