Individual
MR. SHANE V. MOISIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1919 W NORTH AVE STE 200, MILWAUKEE, WI 53205-1101
(414) 257-7610
(414) 266-3735
Mailing address
1919 W NORTH AVE STE 200, MILWAUKEE, WI 53205-1101
(414) 257-7610
(414) 266-3735
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
44961
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
34317100
—
WI
Enumeration date
05/30/2006
Last updated
01/13/2025
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