Provider Demographics
NPI:1326098617
Name:KATANICK, SHELDON L (DO)
Entity Type:Individual
Prefix:DR
First Name:SHELDON
Middle Name:L
Last Name:KATANICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-7439
Mailing Address - Country:US
Mailing Address - Phone:352-237-8100
Mailing Address - Fax:352-237-7286
Practice Address - Street 1:3201 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-7439
Practice Address - Country:US
Practice Address - Phone:352-237-8100
Practice Address - Fax:352-237-7286
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372273200Medicaid
FL372273200Medicaid
FL82769Medicare ID - Type Unspecified