Healthcare Provider Details

I. General information

NPI: 1184389439
Provider Name (Legal Business Name): SHANNAN VICTORINO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NE 5TH TER APT 528
FORT LAUDERDALE FL
33301-1797
US

IV. Provider business mailing address

501 NE 5TH TER APT 528
FORT LAUDERDALE FL
33301-1797
US

V. Phone/Fax

Practice location:
  • Phone: 774-365-9192
  • Fax:
Mailing address:
  • Phone: 774-365-9192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11016276
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: