| Organization Name: | SHORES MEDICAL CENTER |
| NPI Number: | 1215334370 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GERALD WOODARD (OWNER) |
| Mailing Address: | 3512 S Atlantic Blvd Daytona Beach Shores |
| State: | FL US |
| Postal Code: | 32118 |
| Phone Number: | 3867679544 |
| Fax Number: | |
| NPI Enumeration Date: | 12/04/2014 |
| NPI Last Update Date: | 12/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | ARNP 3088302 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |