Basic Information
| Provider Information | |||||||||
| NPI: | 1962466870 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CODADA | ||||||||
| FirstName: | SHIRLEY | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2450 GOODLETTE RD N STE 101 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341034595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396240340 | ||||||||
| FaxNumber: | 2396248101 | ||||||||
| Practice Location | |||||||||
| Address1: | 2450 GOODLETTE RD N STE 101 | ||||||||
| Address2: | |||||||||
| City: | NAPLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 341034595 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2396240340 | ||||||||
| FaxNumber: | 2396248101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2006 | ||||||||
| LastUpdateDate: | 08/10/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME73373 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0002X | ME73373 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 106635800 | 05 | FL | MEDICAID | E3442X | 01 | FL | MEDICARE | OTHER | 49995 | 01 | FL | BCBS | OTHER |