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General NPI Number Information
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NPI Number | 1619209889
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Entity Type | Individual
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Provider Name | WILLIAM SHANE WOODALL PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/12/2010
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 305 S ANDREWS AVE 601
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City | FT LAUDERDALE
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State | FL
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Zip | 33301-1859
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Country | US
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Telephone | 954-767-0273
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Fax |
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Provider Business Mailing Address
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Address Line | 35 VENETIAN WAY 94
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City | MIAMI BEACH
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State | FL
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Zip | 33139-8806
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Country | US
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Telephone | 305-989-1135
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9104825
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License Number State | FL
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