Provider Demographics
NPI:1528516291
Name:SHAWN M. CAZZELL DPM INC
Entity type:Organization
Organization Name:SHAWN M. CAZZELL DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERSTL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-302-6983
Mailing Address - Street 1:6215 N FRESNO ST
Mailing Address - Street 2:STE 108
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5267
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6215 N FRESNO ST
Practice Address - Street 2:STE 108
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5267
Practice Address - Country:US
Practice Address - Phone:559-256-9600
Practice Address - Fax:559-489-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty