Individual
SHAUNDA MARIE RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1947 N FOUNDERS CIR, WICHITA, KS 67206-3548
(316) 613-4680
(316) 613-4906
Mailing address
PO BOX 8035, WICHITA, KS 67208-0035
(316) 689-9135
(316) 689-9769
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
931
NE
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
05-38208
KS
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
OTO12165
PA
Other
Enumeration date
08/20/2008
Last updated
07/01/2015
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