MEDICARE: STEPHEN SHANKLIN 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	207Q00000X	Family Medicine Physician	OS3566	FL

General Provider Information

NPI Number	:	1669445797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN SHANKLIN DO

Provider Business Mailing Address
First Line	:	111 2ND AVE NE
Second Line	:	SUITE 1500
City	:	ST PETERSBURG
State	:	FL
Zip	:	33701-3434
Country	:	US
Telephone Number	:	727-824-0780
Fax Number	:	727-895-1637

Provider Business Practice Location Address
First Line	:	5534 CORTEZ RD W
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34210-2817
Country	:	US
Telephone Number	:	941-757-2100
Fax Number	:	941-757-2101

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

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	05/12/2008

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Directions to “ STEPHEN SHANKLIN DO” Practice Location

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