| Doctor Name: | DR. ANTHONY SHADIACK |
| NPI Number: | 1427328533 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DO |
| License Number: | |
| Business Practice Address: | 7205 Se Maricamp Rd Ocala, FL - 344722105 |
| Business Phone Number: | 3526800324 |
| Business Fax Number: | 3526800173 |
| Mailing Address: | 1425 S Us 301, SUMTERVILLE |
| State: | FL |
| Postal Code: | 335855141 |
| Phone Number: | 3527935900 |
| Fax Number: | 3527938050 |
| NPI Enumeration Date: | 01/05/2012 |
| NPI Last Update Date: | 08/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |