Provider Demographics
NPI:1467826362
Name:SHOCKLEY, MICHAEL DAVID (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DAVID
Last Name:SHOCKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1447 MEDICAL PARK BLVD STE 407
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3183
Mailing Address - Country:US
Mailing Address - Phone:561-333-1335
Mailing Address - Fax:561-333-4252
Practice Address - Street 1:1447 MEDICAL PARK BLVD STE 407
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3183
Practice Address - Country:US
Practice Address - Phone:561-333-1335
Practice Address - Fax:561-333-4252
Is Sole Proprietor?:No
Enumeration Date:2015-11-16
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME175337208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program