Individual
SHANE STEAN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
601 E ROLLINS ST, ADVENTHEALTH MEDICAL GROUP RADIOLOGY AT CENTRAL FLORIDA, ORLANDO, FL 32803-1248
(407) 200-2355
Mailing address
PO BOX 946414, ATLANTA, GA 30394-6414
(407) 200-2355
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
069426
CT
2085R0202X
Diagnostic Radiology Physician
76770
MN
2085R0202X
Diagnostic Radiology Physician
Primary
OS22276
FL
Other
Enumeration date
04/20/2019
Last updated
09/08/2025
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