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General NPI Number Information
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NPI Number | 1518213602
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Entity Type | Organization
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Legal Business Name | SHANE RETINA, P.A.
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Dates
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Enumeration Date | 07/26/2012
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 2401 UNIVERSITY PKWY BUILDING 1, SUITE 205
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City | SARASOTA
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State | FL
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Zip | 34243-2893
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Country | US
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Telephone | 941-351-1200
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Fax | 941-351-1201
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Provider Business Mailing Address
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Address Line | 2401 UNIVERSITY PKWY STE 205
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City | SARASOTA
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State | FL
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Zip | 34243-2973
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Country | US
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Telephone | 941-351-1200
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Fax | 941-351-1201
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | PAIGE SKEIE
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Credential |
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Telephone | 941-351-1200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME106610
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License Number State | FL
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