Healthcare Provider Details

I. General information

NPI: 1154902013
Provider Name (Legal Business Name): SHAWN ANTHONY AMAYA CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2021
Last Update Date: 04/21/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 BEDFORD RD # ROD
ORLANDO FL
32803-1443
US

IV. Provider business mailing address

40140 SWIFT RD
EUSTIS FL
32736-9560
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-7869
  • Fax:
Mailing address:
  • Phone: 954-338-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT14750
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: