Provider Demographics
NPI:1356453021
Name:SHANKLIN, JOSEPH C (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:C
Last Name:SHANKLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2329 SUNSET POINT RD STE 203
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1438
Mailing Address - Country:US
Mailing Address - Phone:727-669-3911
Mailing Address - Fax:727-669-3813
Practice Address - Street 1:2329 SUNSET POINT RD
Practice Address - Street 2:SUITE 203
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1455
Practice Address - Country:US
Practice Address - Phone:727-446-7756
Practice Address - Fax:727-446-5977
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00743122084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3324ZMedicare ID - Type Unspecified
FLH07008Medicare UPIN