Provider Demographics
NPI:1265521660
Name:SHANDS MEDICAL PLAZA
Entity type:Organization
Organization Name:SHANDS MEDICAL PLAZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:WEINBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-265-0111
Mailing Address - Street 1:2701 SW 13TH ST APT D15
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-2069
Mailing Address - Country:US
Mailing Address - Phone:352-275-4278
Mailing Address - Fax:
Practice Address - Street 1:2701 SW 13TH ST APT D15
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-2069
Practice Address - Country:US
Practice Address - Phone:352-275-4278
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL508705283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital