Provider Demographics
NPI:1154589786
Name:SHADDIX, MEREDITH LYNN (DO)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:LYNN
Last Name:SHADDIX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:LYNN
Other - Last Name:KNORSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:5153 NORTH 9TH AVENUE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504
Mailing Address - Country:US
Mailing Address - Phone:850-416-6159
Mailing Address - Fax:850-416-7198
Practice Address - Street 1:5153 NORTH 9TH AVENUE
Practice Address - Street 2:SUITE 305
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504
Practice Address - Country:US
Practice Address - Phone:850-416-6159
Practice Address - Fax:850-416-7198
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS131432086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery