Provider Demographics
NPI:1083858930
Name:SADDLER, SHAWNETTE SIMONE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWNETTE
Middle Name:SIMONE
Last Name:SADDLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-320-3390
Mailing Address - Fax:954-340-4557
Practice Address - Street 1:9750 NW 33RD ST STE 202
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4081
Practice Address - Country:US
Practice Address - Phone:954-320-3390
Practice Address - Fax:954-340-4557
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109668208000000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003801900Medicaid
FL003801900Medicaid