Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | J9805 | TX |
NPI | 1225097546 |
---|---|
Provider Name | Felix Roberto Shardonofsky |
First Address | San Antonio, TX 78207-3154 |
Second Address | San Antonio, TX 78207-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2006 |
Last Update Date | 30/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126552216 | (05) | TX |
F62592 | (02) |