Healthcare Provider Details

I. General information

NPI: 1295582427
Provider Name (Legal Business Name): SHANDOR LOPEZ FIGUEREDO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 05/14/2024
Certification Date: 05/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6700 NW 186TH ST APT 103
HIALEAH FL
33015-3318
US

IV. Provider business mailing address

6700 NW 186TH ST APT 103
HIALEAH FL
33015-3318
US

V. Phone/Fax

Practice location:
  • Phone: 305-301-9009
  • Fax:
Mailing address:
  • Phone: 305-301-9009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11032620
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: