Healthcare Provider Details

I. General information

NPI: 1508351404
Provider Name (Legal Business Name): SHAUN MANSOUR MD, MBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8900 N KENDALL DR
MIAMI FL
33176-2197
US

IV. Provider business mailing address

8370 W FLAGLER ST STE 226
MIAMI FL
33144-2040
US

V. Phone/Fax

Practice location:
  • Phone: 305-928-7249
  • Fax: 305-630-3632
Mailing address:
  • Phone: 305-928-7249
  • Fax: 305-630-3632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT230505
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD204241
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberME183001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: