Healthcare Provider Details

I. General information

NPI: 1376162198
Provider Name (Legal Business Name): SHAWN M ALONSO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2020
Last Update Date: 09/19/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 NW 10TH AVE STE 1140
MIAMI FL
33136-1015
US

IV. Provider business mailing address

8804 RUSTIC TRAIL CT
TAMPA FL
33635-1557
US

V. Phone/Fax

Practice location:
  • Phone: 954-938-3359
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS22487
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: