Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | ME132321 | FL |
NPI | 1003236175 |
---|---|
Provider Name | Shanna Stephen |
First Address | Plantation, FL 33324-3923 |
Second Address | Plantation, FL 33324-2334 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 27/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021690000 | (05) | FL |