Provider Demographics
NPI:1790056711
Name:SCHROEDER, SHANA R (DO)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:R
Last Name:SCHROEDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:RISSMILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4600 LINTON BLVD
Mailing Address - Street 2:S. 340
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-6600
Mailing Address - Country:US
Mailing Address - Phone:561-495-9797
Mailing Address - Fax:
Practice Address - Street 1:4600 LINTON BLVD
Practice Address - Street 2:S. 340
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6600
Practice Address - Country:US
Practice Address - Phone:561-495-9797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO 2575207R00000X
FLOS11685207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine