Healthcare Provider Details

I. General information

NPI: 1093125635
Provider Name (Legal Business Name): SHAUN HUTTON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MILITARY TRL
JUPITER FL
33458-5799
US

IV. Provider business mailing address

1720 E TIFFANY DR
WEST PALM BEACH FL
33407-3235
US

V. Phone/Fax

Practice location:
  • Phone: 561-744-7954
  • Fax:
Mailing address:
  • Phone: 561-744-7954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: