Provider Demographics
NPI:1780046177
Name:HOMANS, SHAWN DARMOND (SPORTS MEDICINE SPEC)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:DARMOND
Last Name:HOMANS
Suffix:
Gender:M
Credentials:SPORTS MEDICINE SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12903 WOODLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-3976
Mailing Address - Country:US
Mailing Address - Phone:813-334-8787
Mailing Address - Fax:
Practice Address - Street 1:13539 N FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3203
Practice Address - Country:US
Practice Address - Phone:813-961-0595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIFPA CERTIFICATION2081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine