Provider Demographics
NPI:1225324445
Name:MCSHAN MEDICAL DEVICES LLC
Entity Type:Organization
Organization Name:MCSHAN MEDICAL DEVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCSHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-889-0329
Mailing Address - Street 1:2855 PONKAN SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-6423
Mailing Address - Country:US
Mailing Address - Phone:407-889-0329
Mailing Address - Fax:
Practice Address - Street 1:2855 PONKAN SUMMIT DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-6423
Practice Address - Country:US
Practice Address - Phone:407-889-0329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-27
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies