Provider Demographics
NPI:1609192509
Name:BHAGWANDIN, SHANEL (DO)
Entity Type:Individual
Prefix:
First Name:SHANEL
Middle Name:
Last Name:BHAGWANDIN
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 1:1210 S OLD DIXIE HWY FL 2
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-7205
Mailing Address - Country:US
Mailing Address - Phone:561-741-5570
Mailing Address - Fax:561-741-5574
Practice Address - Street 1:1210 S OLD DIXIE HWY FL 2
Practice Address - Street 2:
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-7205
Practice Address - Country:US
Practice Address - Phone:561-741-5570
Practice Address - Fax:561-741-5574
Is Sole Proprietor?:No
Enumeration Date:2010-04-16
Last Update Date:2021-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2785082086X0206X
FLOS148002086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology