Healthcare Provider Details

I. General information

NPI: 1912701830
Provider Name (Legal Business Name): WILSON SHULTERBRANDT HOLDINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13569 PANAMA CITY BEACH PKWY
PANAMA CITY BEACH FL
32407-2847
US

IV. Provider business mailing address

3316 CHARLES CT
CHALMETTE LA
70043-2615
US

V. Phone/Fax

Practice location:
  • Phone: 850-238-8563
  • Fax: 850-238-8564
Mailing address:
  • Phone: 985-517-4561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGEL SHULTERBRANDT
Title or Position: CO-OWNER
Credential:
Phone: 985-517-4561