Healthcare Provider Details

I. General information

NPI: 1558821850
Provider Name (Legal Business Name): MUNCHKINS PEDIATRICS, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13540 17TH ST
DADE CITY FL
33525-5244
US

IV. Provider business mailing address

20718 HIGHPOND LN
DADE CITY FL
33523-6555
US

V. Phone/Fax

Practice location:
  • Phone: 352-437-3107
  • Fax: 352-437-3120
Mailing address:
  • Phone: 813-892-5501
  • Fax: 352-437-3120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. SHAUNA MICHELE DESCHAMPS
Title or Position: OWNER/PROVIDER
Credential: APRN
Phone: 352-437-3107