Individual
DR. SHAWN MICHAEL SANICOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
2835 N GRANDVIEW BLVD STE 300, PEWAUKEE, WI 53072-5591
(262) 542-3779
(262) 542-4428
Mailing address
2835 N GRANDVIEW BLVD, STE 300, PEWAUKEE, WI 53072-5591
(262) 542-3779
(262) 542-4428
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
883025
WI
213ES0000X
Sports Medicine Podiatrist
883025
WI
213ES0103X
Foot & Ankle Surgery Podiatrist
883025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1316994924
NPI GROUP
WI
01
—
1457356305
INDIVIDUAL NPI
WI
Enumeration date
06/16/2005
Last updated
02/16/2022
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