Provider Demographics
NPI:1952780934
Name:DRAHOS, SHANE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANE
Middle Name:MICHAEL
Last Name:DRAHOS
Suffix:
Gender:M
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 941455
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-1455
Mailing Address - Country:US
Mailing Address - Phone:407-573-5733
Mailing Address - Fax:407-573-5491
Practice Address - Street 1:187 S. BOYD STREET
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3574
Practice Address - Country:US
Practice Address - Phone:407-573-5733
Practice Address - Fax:407-573-5491
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-25
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133830207QS1201X, 207QS1201X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program