Provider Demographics
NPI:1083664874
Name:SHENKMAN, CARL TYLER (MD, JD, LLM)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:TYLER
Last Name:SHENKMAN
Suffix:
Gender:M
Credentials:MD, JD, LLM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S LINCOLN AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-5964
Mailing Address - Country:US
Mailing Address - Phone:727-357-7828
Mailing Address - Fax:727-337-7646
Practice Address - Street 1:501 S LINCOLN AVE STE 22
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-5964
Practice Address - Country:US
Practice Address - Phone:727-357-7828
Practice Address - Fax:727-337-7646
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA360002084N0400X
FLME118247208M00000X, 2084N0400X
GA036000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL011898500Medicaid
GAP00187661OtherRAILROAD MEDICARE PIN
GA000516942HMedicaid
GAP00187661OtherRAILROAD MEDICARE PIN
GA13BDDVPMedicare PIN
FL011898500Medicaid