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NPI Code Detail

MEDICARE: BARBARA SHIDELER MD

MEDICARE: BARBARA SHIDELER MD
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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician04-27150KS
2207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianME152373FL
3207ZC0500XCytopathology Physician04-27150KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104892348
Entity Type Code : Individual
Provider Name (Legal Business Name) : BARBARA SHIDELER MD
Provider Business Mailing Address
First Line : PO BOX 741087
Second Line :
City : ATLANTA
State : GA
Zip : 30374-1087
Country : US
Telephone Number : 941-627-6128
Fax Number : 941-764-7071
Provider Business Practice Location Address
First Line : 21298 OLEAN BLVD
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33952-6705
Country : US
Telephone Number : 941-627-6128
Fax Number : 941-764-7071
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2006
Last Update Date : 06/06/2024

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Directions to “ BARBARA SHIDELER MD” Practice Location

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