Healthcare Provider Details

I. General information

NPI: 1184292302
Provider Name (Legal Business Name): SHAWN MCNALLY DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8787 BRYAN DAIRY RD STE 200
LARGO FL
33777-1253
US

IV. Provider business mailing address

2995 DREW ST FL 2
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 727-391-6296
  • Fax:
Mailing address:
  • Phone: 727-315-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN11044830
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: