Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN20910 | FL |
NPI | 1033518485 |
---|---|
Provider Name | Dr. Shana H Capra |
First Address | Delray Beach, FL 33446-4110 |
Second Address | Delray Beach, FL 33446-4110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2014 |
Last Update Date | 18/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013292400 | (05) | FL |