Healthcare Provider Details

I. General information

NPI: 1407222193
Provider Name (Legal Business Name): MR. SHAWN HUFFMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 08/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2751 ENTERPRISE RD SUITE 106
ORANGE CITY FL
32763-8256
US

IV. Provider business mailing address

2751 ENTERPRISE RD SUITE 106
ORANGE CITY FL
32763-8256
US

V. Phone/Fax

Practice location:
  • Phone: 386-775-0220
  • Fax: 386-775-0221
Mailing address:
  • Phone: 386-775-0220
  • Fax: 386-775-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberAS5115
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: