Provider Demographics
NPI:1750328514
Name:SHOEMAKER, WHITNEY E (DO, FACOOG)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:E
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:DO, FACOOG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:598 STERTHAUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5128
Mailing Address - Country:US
Mailing Address - Phone:386-256-2565
Mailing Address - Fax:386-256-2567
Practice Address - Street 1:598 STERTHAUS DRIVE
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5128
Practice Address - Country:US
Practice Address - Phone:386-256-2565
Practice Address - Fax:386-256-2567
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010802L207VG0400X
FLOS9499207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013235910002Medicaid
FLHT984ZMedicare PIN
FLHT984ZMedicare UPIN
PAI26404Medicare UPIN
PA088934Medicare ID - Type UnspecifiedIND. NUMBER