Individual
THOMAS J SHAKNOVSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
214 COVELL RD, CRESTVIEW, FL 32539-6060
(850) 864-4005
Mailing address
PO BOX 419076, BOSTON, MA 02241-9076
(610) 644-8900
(484) 924-0053
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
25MA09329900
NJ
208600000X
Surgery Physician
Primary
OS16658
FL
208C00000X
Colon & Rectal Surgery Physician
16658
FL
Other
Enumeration date
06/23/2009
Last updated
08/24/2022
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