Healthcare Provider Details

I. General information

NPI: 1598020059
Provider Name (Legal Business Name): BRANDON SHUTTY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 12TH ST STE 112
KEY WEST FL
33040-4087
US

IV. Provider business mailing address

7421 N UNIVERSITY DR STE 307
TAMARAC FL
33321-6102
US

V. Phone/Fax

Practice location:
  • Phone: 305-363-4950
  • Fax: 305-363-4951
Mailing address:
  • Phone: 954-720-7272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberOS13979
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberOS13979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: