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General NPI Number Information
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NPI Number | 1548757800
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Entity Type | Individual
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Provider Name | LOGAN T SHANNON DPM
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Gender | Male
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Dates
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Enumeration Date | 04/21/2018
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 943 S BENEVA RD STE 113
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City | SARASOTA
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State | FL
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Zip | 34232-2471
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Country | US
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Telephone | 941-316-0133
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Fax | 941-957-3641
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Provider Business Mailing Address
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Address Line | 943 S BENEVA RD STE 306
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City | SARASOTA
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State | FL
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Zip | 34232-2499
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Country | US
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Telephone | 941-955-1108
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Fax | 941-954-4440
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103301320
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | 0103301320
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO4392
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License Number State | FL
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