Provider Demographics
NPI:1063479798
Name:BERKOWITZ, SHAWN ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ANTHONY
Last Name:BERKOWITZ
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:SHAWN
Other - Middle Name:ANTHONY
Other - Last Name:BERKOWITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6310 CAPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5013
Mailing Address - Country:US
Mailing Address - Phone:941-552-7686
Mailing Address - Fax:941-806-4121
Practice Address - Street 1:5414 BEAUMONT CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5266
Practice Address - Country:US
Practice Address - Phone:813-889-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA257826207QG0300X
NY237935207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
06158729OtherECFMG #
NY02700838Medicaid
06158729OtherECFMG #
NY02700838Medicaid