MEDICARE: DR. SHANI STUDNIK DO

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	207N00000X	Dermatology Physician	OS7756	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1366447906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANI STUDNIK DO

Provider Business Mailing Address
First Line	:	17170 ROYAL PALM BLVD
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-2339
Country	:	US
Telephone Number	:	954-349-3376
Fax Number	:	954-385-8572

Provider Business Practice Location Address
First Line	:	17170 ROYAL PALM BLVD
Second Line	:
City	:	WESTON
State	:	FL
Zip	:	33326-2339
Country	:	US
Telephone Number	:	954-349-3376
Fax Number	:	954-385-8572

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	08/07/2012

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