Provider Demographics
NPI:1407963010
Name:BOYER, SHANNON L (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:L
Last Name:BOYER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2702 REW CIR
Mailing Address - Street 2:SUITE A
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4226
Mailing Address - Country:US
Mailing Address - Phone:407-656-5505
Mailing Address - Fax:407-656-9688
Practice Address - Street 1:2702 REW CIR
Practice Address - Street 2:SUITE A
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4226
Practice Address - Country:US
Practice Address - Phone:407-656-5505
Practice Address - Fax:407-656-9688
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0036398207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL039822500Medicaid
FLM3CO4OtherBCBS GROUP ID
FL039822500Medicaid
FL0892440001Medicare NSC