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General NPI Number Information
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NPI Number | 1871482984
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Entity Type | Organization
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Legal Business Name | THE PODIATRY CLINIC, PA
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Dates
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Enumeration Date | 07/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 300 RIVERSIDE DR E STE 2000
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City | BRADENTON
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State | FL
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Zip | 34208-1023
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Country | US
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Telephone | 941-666-5088
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Fax | 239-209-9686
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Provider Business Mailing Address
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Address Line | 300 RIVERSIDE DR E STE 2000
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City | BRADENTON
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State | FL
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Zip | 34208-1023
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Country | US
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Telephone | 941-666-5088
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Fax |
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Authorized Official
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Title or Position | PODIATRIST/OWNER/PRESIDENT
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Name | DR. SEAN DIEN SHANAHAN
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Credential | DPM
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Telephone | 941-666-5088
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number |
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License Number State |
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