Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO 3200 | FL |
NPI | 1013967249 |
---|---|
Provider Name | Amber M Shane |
First Address | Orlando, FL 32803-3727 |
Second Address | Orlando, FL 32828-4315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2006 |
Last Update Date | 10/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
340576100 | (05) | FL |
P00431274 | RAIL ROAD MEDICARE (01) | FL |
V09740 | (02) | FL |