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General NPI Number Information
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NPI Number | 1356308316
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Entity Type | Individual
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Provider Name | SHANE A ANDREW DO
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Gender | Male
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 4424 E FLAMINGO AVE SUITE 110
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City | NAMPA
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State | ID
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Zip | 83687
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Country | US
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Telephone | 208-288-4700
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Fax | 208-288-4720
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Provider Business Mailing Address
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Address Line | 3340 E GOLDSTONE WAY
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City | MERIDIAN
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State | ID
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Zip | 83642-1026
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Country | US
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Telephone | 208-367-5170
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Fax | 208-367-5180
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | O0443
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | OS9764
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | O-0443
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License Number State | ID
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