Provider Demographics
NPI:1336188176
Name:VANDEMARK, SHAWN DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:DAVID
Last Name:VANDEMARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 0070
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31603-0070
Mailing Address - Country:US
Mailing Address - Phone:229-333-1711
Mailing Address - Fax:229-333-1719
Practice Address - Street 1:2409 N PATTERSON ST STE 200
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-2512
Practice Address - Country:US
Practice Address - Phone:229-333-1711
Practice Address - Fax:229-333-1719
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2018-03-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA057510208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery