Provider Demographics
NPI:1215955026
Name:COTTER, SHENARY JOANN (MD)
Entity type:Individual
Prefix:DR
First Name:SHENARY
Middle Name:JOANN
Last Name:COTTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHENARY
Other - Middle Name:ANN
Other - Last Name:COTTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-392-4541
Mailing Address - Fax:352-332-7116
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-4541
Practice Address - Fax:352-332-7116
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77793207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263435000Medicaid
FL06975ZMedicare PIN
H18876Medicare UPIN