Healthcare Provider Details

I. General information

NPI: 1265408025
Provider Name (Legal Business Name): SHANNA M MIRANTI P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 CROSSPOINTE DR
NAPLES FL
34110-0930
US

IV. Provider business mailing address

15051 S TAMIAMI TRL SUITE 203
FORT MYERS FL
33908-5182
US

V. Phone/Fax

Practice location:
  • Phone: 239-596-9075
  • Fax: 239-596-9076
Mailing address:
  • Phone: 239-437-8810
  • Fax: 239-437-8875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 9102096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: