Provider Demographics
NPI:1730506932
Name:STECKLEIN, SHANE RICHARD (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:SHANE
Middle Name:RICHARD
Last Name:STECKLEIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1400 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2134
Mailing Address - Country:US
Mailing Address - Phone:877-876-3627
Mailing Address - Fax:321-841-3794
Practice Address - Street 1:1400 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2134
Practice Address - Country:US
Practice Address - Phone:877-876-3627
Practice Address - Fax:321-841-3794
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-419412085R0001X
FLME1767532085R0001X
MO20190080772085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology