Healthcare Provider Details

I. General information

NPI: 1518213602
Provider Name (Legal Business Name): SHANE RETINA, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 UNIVERSITY PKWY BUILDING 1, SUITE 205
SARASOTA FL
34243-2893
US

IV. Provider business mailing address

2401 UNIVERSITY PKWY STE 205
SARASOTA FL
34243-2973
US

V. Phone/Fax

Practice location:
  • Phone: 941-351-1200
  • Fax: 941-351-1201
Mailing address:
  • Phone: 941-351-1200
  • Fax: 941-351-1201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME106610
License Number StateFL

VIII. Authorized Official

Name: PAIGE SKEIE
Title or Position: PRACTICE MANAGER
Credential:
Phone: 941-351-1200