Provider Demographics
NPI:1003871286
Name:WANG, SHUDONG (AP)
Entity Type:Individual
Prefix:
First Name:SHUDONG
Middle Name:
Last Name:WANG
Suffix:
Gender:M
Credentials:AP
Other - Prefix:DR
Other - First Name:SHUDONG
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AP
Mailing Address - Street 1:4001 N OCEAN DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5928
Mailing Address - Country:US
Mailing Address - Phone:954-772-9696
Mailing Address - Fax:954-772-9696
Practice Address - Street 1:4001 N OCEAN DR
Practice Address - Street 2:SUITE 206
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5928
Practice Address - Country:US
Practice Address - Phone:954-772-9696
Practice Address - Fax:954-772-9696
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1272171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC003MOtherBC/BS PROVIDER ID