MR. DOUGLAS JAMES SHADLE (NPI# 1558376905) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558376905 |
| Entity Type | Individual |
| Full Name | MR. DOUGLAS JAMES SHADLE |
| Credential | MD |
| Practice Address |
425 Cross St Suite 116 Punta Gorda FL 33950-4872 |
| Practice Telephone | 9416394248 |
| Practice Fax Number | 9416398002 |
| Mailing Telephone | 9416394248 |
| Mailing Fax Number | 9416398002 |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 2084F0202X |
Psychiatry & Neurology Specialization: Forensic Psychiatry |
ME76084 | FL | Allopathic & Osteopathic Physicians |
| X | 2084P0800X |
Psychiatry & Neurology Specialization: Psychiatry |
ME76084 | FL | Allopathic & Osteopathic Physicians |
| X | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
ME76084 | FL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WA | HLTH PROF QUAL ASSURANCE | MD19739 | 01 |
| FL | DEPT OF HEALTH | ME76084 | 01 |
| Street Address |
425 CROSS ST SUITE 116 |
| City | PUNTA GORDA |
| State | FL |
| Zip Code | 33950-4872 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023001849 | Deborah Burgess | Counselor | 425 Cross St, 111, Punta Gorda, FL 33950-4877 | 2005-08-26 |
| 1073877643 | Daniel B Goldman Phd, LLC | Psychologist | 425 Cross St, 111, Punta Gorda, FL 33950-4877 | 2012-06-28 |
| 1114288487 | Daniel Bass Goldman | Psychologist | 425 Cross St, #111, Punta Gorda, FL 33950-4877 | 2012-06-04 |
| 1003049172 | Peace River Psychology Center Pa | Psychologist | 425 Cross St, Ste 111, Punta Gorda, FL 33950-4877 | 2009-08-24 |
| 1487890547 | Wilshire Medical Arts Pa | Internal Medicine | 425 Cross St, Suite 311 & 312, Punta Gorda, FL 33950-4877 | 2008-12-19 |
| 1497829584 | Luis D Berrios | Family Medicine | 425 Cross St, Unit 311 & 312, Punta Gorda, FL 33950-4877 | 2006-11-20 |
| 1962519025 | Suzanne Spross | Psychologist | 425 Cross St, Punta Gorda, FL 33950-4877 | 2006-08-24 |
| 1346233095 | Steven R Pollard | Psychologist | 425 Cross St, 111, Punta Gorda, FL 33950-4877 | 2005-08-29 |
| 1063405785 | Karin Galliano | Psychologist | 425 Cross St, 111, Punta Gorda, FL 33950-4877 | 2005-08-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295291979 | Kristin Wilson | Nurse Practitioner | 350 E Olympia Ave, Suite 111, Punta Gorda, FL 33950 | 2019-02-18 |
| 1750856993 | Medical Risk Solutions | Family Medicine | 514 East Grace Street, Punta Gorda, FL 33950 | 2018-10-03 |
| 1457858607 | Janet Miller Dawson | Nurse Practitioner | Charlotte Behavioral Health Care, 1700 Education Avenue, Punta Gorda, FL 33950 | 2018-04-12 |
| 1730689290 | Suncoast Neuropsychiatric Wellness Center LLC | Psychiatry & Neurology | 25097 E Olympia Ave, #200, Punta Gorda, FL 33950 | 2018-02-20 |
| 1306351424 | Laura Cara Carlisle | Developmental Therapist | 2440 W Marion Ave, Punta Gorda, FL 33950 | 2017-12-12 |
| 1629591722 | Rachel Guyton Irias | Behavior Technician | 321 W Grace St, Punta Gorda, FL 33950 | 2017-07-20 |
| 1730636713 | William Bartley Hoke | Specialist/Technologist | 733 E.oympia Ave, Punta Gorda, FL 33950 | 2016-09-07 |
| 1861868770 | Jason Burns | Physical Therapist | 3857 Acline Rd Unit 107, Punta Gorda, FL 33950 | 2015-08-14 |
| 1073935409 | Heather Lynn Darmetko | Nurse Practitioner | 713 E. Marion Ave. 1211 Suite 1211, Punta Gorda, FL 33950 | 2014-01-21 |
| 1568706380 | Steven Michael Byrne | Nurse Practitioner | 2310 Tamiami Trail, Suite 2101, Punta Gorda, FL 33950 | 2012-11-16 |
| Find all providers in zip 33950 | ||||
| Taxonomy Code | 2084F0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Forensic Psychiatry |
| Forensic Psychiatry is a subspecialty with psychiatric focus on interrelationships with civil, criminal and administrative law, evaluation and specialized treatment of individuals involved with the legal system, incarcerated in jails, prisons, and forensic psychiatry hospitals. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487000816 | Barbara Stein | Psychiatry & Neurology | 200 2nd Ave S # 169, St Petersburg, FL 33701-4313 | 2016-05-04 |
| 1205278454 | Medical & Psychiatric Insitiute of Florida, Inc. | Psychiatry & Neurology | 6056 Central Park Blvd, Port Orange, FL 32127-9539 | 2013-07-29 |
| 1518233451 | H. Barry Miller, M.d., P.a. | Psychiatry & Neurology | 3363 Sheridan Street, Suite #210, Hollywood, FL 33021-3658 | 2012-03-26 |
| 1922328228 | Jacqueline E Barrett Md, Pa | Psychiatry & Neurology | 4651 Sheridan St Ste 450, Hollywood, FL 33021-3415 | 2010-06-09 |
| 1144548611 | Family & Forensic Psychiatry | Psychiatry & Neurology | 4965 Sw 91st Ter Ste A, Gainesville, FL 32608-8155 | 2010-05-09 |
| 1629200647 | Asad Hamid Khan | Psychiatry & Neurology | 927 Beville Rd, Suite # 7, South Daytona, FL 32119-1768 | 2009-08-10 |
| 1619160298 | Alan J. Waldman | Psychiatry & Neurology | 2727 Nw 43rd Street, Gainesville, FL 32606 | 2007-08-27 |
| 1497948996 | Ronald M Chase | Psychiatry & Neurology | 32910 Lakeshore Dr, Tavares, FL 32778-5013 | 2007-08-20 |
| 1568668168 | Jacqueline Elaine Barrett | Psychiatry & Neurology | 816 Nw Avenue D, Belle Glade, FL 33430-2904 | 2007-06-21 |
| 1366657694 | David Grippe | Psychiatry & Neurology | 2733 Mount Pleasant Rd, Quincy, FL 32352-6684 | 2007-05-11 |
| Find all providers with the same taxonomy | ||||
| City | PUNTA GORDA |
| Zip Code | 33950 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.