Healthcare Provider Details

I. General information

NPI: 1285957464
Provider Name (Legal Business Name): SHANNA KOWALSKY-HERBST DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2010
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 SW 60TH CT STE 206
MIAMI FL
33155-4070
US

IV. Provider business mailing address

3200 SW 60TH CT STE 206
MIAMI FL
33155-4070
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-6511
  • Fax:
Mailing address:
  • Phone: 305-666-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberUO1619
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number256794
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number256794
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberOS17443
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: