Healthcare Provider Details

I. General information

NPI: 1992620520
Provider Name (Legal Business Name): SHAUNI COOLEY DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410A BRICKYARD RD
CHIPLEY FL
32428-5966
US

IV. Provider business mailing address

3323 DOUGLAS FERRY RD
BONIFAY FL
32425-8711
US

V. Phone/Fax

Practice location:
  • Phone: 850-415-1411
  • Fax:
Mailing address:
  • Phone: 850-703-0038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: