Healthcare Provider Details

I. General information

NPI: 1447731708
Provider Name (Legal Business Name): SHANNA ANN MAIORANA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 N US HIGHWAY 1
FORT PIERCE FL
34950-9125
US

IV. Provider business mailing address

827 18TH ST
VERO BEACH FL
32960-6481
US

V. Phone/Fax

Practice location:
  • Phone: 772-468-9900
  • Fax: 772-468-2364
Mailing address:
  • Phone: 772-925-8190
  • Fax: 772-925-8199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN9344400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: