Basic Information
Provider Information
NPI: 1982729109
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHLAPACK
FirstName: MATTHEW
MiddleName: ANDREW
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1020 LAKE SUMTER LNDG
Address2:  
City: THE VILLAGES
State: FL
PostalCode: 321622699
CountryCode: US
TelephoneNumber: 3526748905
FaxNumber: 3526748901
Practice Location
Address1: 2955 BROWNWOOD BLVD
Address2:  
City: THE VILLAGES
State: FL
PostalCode: 321632036
CountryCode: US
TelephoneNumber: 3526748700
FaxNumber: 3526748714
Other Information
ProviderEnumerationDate: 03/20/2007
LastUpdateDate: 05/19/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/19/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101XME108982FLY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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