Provider Demographics
NPI:1124384029
Name:SENDZISCHEW SHANE, MORGAN ALLYN (MD)
Entity Type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:ALLYN
Last Name:SENDZISCHEW SHANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 N.W. 12TH AVENUE
Mailing Address - Street 2:INTERNAL MEDICINE CENTRAL BUILDING 600D
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1096
Mailing Address - Country:US
Mailing Address - Phone:305-585-5215
Mailing Address - Fax:305-585-8137
Practice Address - Street 1:1120 NW 14TH ST # 1184
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-2107
Practice Address - Country:US
Practice Address - Phone:305-243-8644
Practice Address - Fax:305-243-7546
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME124721207R00000X, 207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program