MEDICARE: SHUDONG WANG A.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AP 1272	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C003M	OTHER	FL	BC/BS PROVIDER ID

General Provider Information

NPI Number	:	1003871286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHUDONG WANG A.P.

Provider Business Mailing Address
First Line	:	4001 N OCEAN DR
Second Line	:	SUITE 206
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5928
Country	:	US
Telephone Number	:	954-772-9696
Fax Number	:	954-772-9696

Provider Business Practice Location Address
First Line	:	4001 N OCEAN DR
Second Line	:	SUITE 206
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5928
Country	:	US
Telephone Number	:	954-772-9696
Fax Number	:	954-772-9696

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/08/2007

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Directions to “ SHUDONG WANG A.P.” Practice Location

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