Provider Demographics
NPI:1669445797
Name:SHANKLIN, STEPHEN (DO)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:SHANKLIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 2ND AVE NE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3434
Mailing Address - Country:US
Mailing Address - Phone:727-824-0780
Mailing Address - Fax:727-895-1637
Practice Address - Street 1:5534 CORTEZ RD W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-2817
Practice Address - Country:US
Practice Address - Phone:941-757-2100
Practice Address - Fax:941-757-2101
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5248ZMedicare ID - Type Unspecified
I37515Medicare UPIN