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NPI Code Detail

MEDICARE: MS. SHANIEL GORDON FNP

MEDICARE: MS. SHANIEL GORDON FNP
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
1363LF0000XFamily Nurse Practitioner11029731FL
2363LP0200XPediatric Nurse PractitionerAPRN11029731FL

General Provider Information

NPI Number : 1033945472
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHANIEL GORDON FNP
Provider Business Mailing Address
First Line : 515 WEKIVA COMMONS CIR
Second Line :
City : APOPKA
State : FL
Zip : 32712-3645
Country : US
Telephone Number : 407-464-9516
Fax Number : 407-464-9519
Provider Business Practice Location Address
First Line : 515 WEKIVA COMMONS CIR
Second Line :
City : APOPKA
State : FL
Zip : 32712-3645
Country : US
Telephone Number : 407-464-9516
Fax Number : 407-464-9519
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/11/2024
Last Update Date : 03/03/2026

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