Provider Demographics
NPI:1962466870
Name:CODADA, SHIRLEY N (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:N
Last Name:CODADA
Suffix:
Gender:F
Credentials:MD
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 100277
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0277
Mailing Address - Country:US
Mailing Address - Phone:352-265-0655
Mailing Address - Fax:352-265-1107
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-4595
Practice Address - Country:US
Practice Address - Phone:352-265-0655
Practice Address - Fax:352-265-1107
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73373207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL49995OtherBCBS
FL106635800Medicaid
FL49995OtherBCBS
FL106635800Medicaid