Healthcare Provider Details

I. General information

NPI: 1407963010
Provider Name (Legal Business Name): SHANNON L BOYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 09/14/2020
Certification Date: 09/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 REW CIR SUITE A
OCOEE FL
34761-4226
US

IV. Provider business mailing address

2702 REW CIR SUITE A
OCOEE FL
34761-4226
US

V. Phone/Fax

Practice location:
  • Phone: 407-656-5505
  • Fax: 407-656-9688
Mailing address:
  • Phone: 407-656-5505
  • Fax: 407-656-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME0036398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: