Provider Demographics
NPI:1770502015
Name:SHANDLES, IRA DAVID (DPM)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:DAVID
Last Name:SHANDLES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 271490
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33688-1490
Mailing Address - Country:US
Mailing Address - Phone:813-264-5100
Mailing Address - Fax:813-264-7476
Practice Address - Street 1:14310 N DALE MABRY HWY STE 180
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2059
Practice Address - Country:US
Practice Address - Phone:813-960-0115
Practice Address - Fax:813-254-9192
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPOOOO1105213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87772Medicare PIN