Provider Demographics
NPI:1871482984
Name:THE PODIATRY CLINIC
Entity type:Organization
Organization Name:THE PODIATRY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST/OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:DIEN
Authorized Official - Last Name:SHANAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:813-436-6777
Mailing Address - Street 1:13026 WATERBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-3908
Mailing Address - Country:US
Mailing Address - Phone:813-436-6777
Mailing Address - Fax:
Practice Address - Street 1:300 RIVERSIDE DR E STE 2000
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1023
Practice Address - Country:US
Practice Address - Phone:813-436-6777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-02
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty