Healthcare Provider Details

I. General information

NPI: 1548605967
Provider Name (Legal Business Name): SHAUNA E BERRY D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9776 BONITA BEACH RD SE STE 202B
BONITA SPRINGS FL
34135-4775
US

IV. Provider business mailing address

9776 BONITA BEACH RD SE STE 202B
BONITA SPRINGS FL
34135-4775
US

V. Phone/Fax

Practice location:
  • Phone: 239-308-0063
  • Fax:
Mailing address:
  • Phone: 239-308-0063
  • Fax: 239-495-4377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0109X
TaxonomyNeuro-ophthalmology Physician
License NumberOS16160
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS16160
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License NumberOS16160
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: