Provider Demographics
NPI:1639325533
Name:SHAYNE N MOYLES DO PL
Entity Type:Organization
Organization Name:SHAYNE N MOYLES DO PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHAYNE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:MOYLES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:754-234-3690
Mailing Address - Street 1:PO BOX 67061
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33736-7061
Mailing Address - Country:US
Mailing Address - Phone:727-504-0044
Mailing Address - Fax:
Practice Address - Street 1:1615 PASADENA AVE S
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4516
Practice Address - Country:US
Practice Address - Phone:727-504-0044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-11
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty