SHANE STEAN PETERSON DO NPI 1609439066

NPI Information

  • NPI: 1609439066
  • Provider Name: SHANE STEAN PETERSON, DO
  • Classification: Radiology - 2085R0202X
  • Specialization: Diagnostic Radiology
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 601 E ROLLINS ST
    ADVENTHEALTH MEDICAL GROUP RADIOLOGY AT CENTRAL FLORIDA
    ORLANDO, FL
    ZIP 32803
  • Phone: (407) 200-2355

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NPI Details

Shane Stean Peterson, DO is a diagnostic radiology radiology in Orlando, FL with 6 years of experience. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Shane Stean Peterson, DO NPI is 1609439066. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: ARIZONA COLLEGE OF OSTEOPATHIC MEDICINE MID WESTERN UNIVERSITY
Graduation Year:2019

The provider's business location address is:

601 E ROLLINS ST
ADVENTHEALTH MEDICAL GROUP RADIOLOGY AT CENTRAL FLORIDA
ORLANDO, FL
ZIP 32803-248
Phone: (407) 200-2355

The NPI 1609439066 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/20/2019 and was last updated on 9/8/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12085R0202XRadiologyDiagnostic RadiologyOS22276FLORIDAYes
22085R0202XRadiologyDiagnostic Radiology069426CONNECTICUTNo
32085R0202XRadiologyDiagnostic Radiology76770MINNESOTANo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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