Healthcare Provider Details

I. General information

NPI: 1336565928
Provider Name (Legal Business Name): SHANNON CALUDA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 03/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

543 FONTAINE ST STE B
PENSACOLA FL
32503-2058
US

IV. Provider business mailing address

1125 SOUNDVIEW TRL
GULF BREEZE FL
32561-4724
US

V. Phone/Fax

Practice location:
  • Phone: 850-474-0155
  • Fax:
Mailing address:
  • Phone: 850-501-5766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberME100871
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: