Provider Demographics
NPI:1366447906
Name:STUDNIK, SHANI (DO)
Entity Type:Individual
Prefix:DR
First Name:SHANI
Middle Name:
Last Name:STUDNIK
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 1:17170 ROYAL PALM BLVD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2339
Mailing Address - Country:US
Mailing Address - Phone:954-349-3376
Mailing Address - Fax:954-385-8572
Practice Address - Street 1:17170 ROYAL PALM BLVD
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2339
Practice Address - Country:US
Practice Address - Phone:954-349-3376
Practice Address - Fax:954-385-8572
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7756207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE5756YMedicare ID - Type Unspecified
FLH40934Medicare UPIN