Healthcare Provider Details

I. General information

NPI: 1942120852
Provider Name (Legal Business Name): SHAWN DUANE VANSCOOTER LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2852 VIA CAMPANIA ST
FORT MYERS FL
33905-5557
US

IV. Provider business mailing address

2852 VIA CAMPANIA ST
FORT MYERS FL
33905-5557
US

V. Phone/Fax

Practice location:
  • Phone: 585-750-8009
  • Fax:
Mailing address:
  • Phone: 585-750-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number5258328
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: