Provider Demographics
NPI:1407159924
Name:LANGLEY, SHAWNA L (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:L
Last Name:LANGLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:L
Other - Last Name:PERSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2160 COLONIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1410
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:820 GOODLETTE RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34102-5445
Practice Address - Country:US
Practice Address - Phone:239-434-0166
Practice Address - Fax:239-434-7553
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105812207N00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology