Provider Demographics
NPI:1174845622
Name:SHANNON FLOYD DPM PA
Entity Type:Organization
Organization Name:SHANNON FLOYD DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOYD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:917-207-3328
Mailing Address - Street 1:4900 SW 46TH CT APT 2108
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-6287
Mailing Address - Country:US
Mailing Address - Phone:917-207-3328
Mailing Address - Fax:
Practice Address - Street 1:11834 COUNTY ROAD 101
Practice Address - Street 2:SUITE 203
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32162-9340
Practice Address - Country:US
Practice Address - Phone:352-633-8230
Practice Address - Fax:352-633-8232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3406213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty