Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME48023 | FL |
NPI | 1104861939 |
---|---|
Provider Name | Dr. Shirley Alice Marineau |
First Address | Naples, FL 34110-1414 |
Second Address | Naples, FL 34110-1414 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2006 |
Last Update Date | 23/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47177100 | (05) | FL |
D51095 | (02) | FL |