Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | ME146027 | FL |
NPI | 1477967768 |
---|---|
Provider Name | Peter James Shekailo |
First Address | Clermont, FL 34711-1915 |
Second Address | Clermont, FL 34711-1915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2014 |
Last Update Date | 04/03/2021 |