Most Relevant Information
Provider Data
| NPI Number: | 1003509100 |
| Provider Name: | SHANE MICHAEL ANDERSON PA-C |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/02/2023 |
| Last Updated: | 06/27/2023 |
Provider Practice Location
13020 N TELECOM PKWY
TEMPLE TERRACE
FL
336370925
Practice Location Phone/Fax
| Phone: | 8139789700 |
| Fax: | 8135586185 |
Provider Mailing Location
12923 LAKESHORE N
AUBURN
CA
956028134
Provider Mailing Phone/Fax
| Phone: | 5304010234 |
| Fax: |