Healthcare Provider Details

I. General information

NPI: 1558712687
Provider Name (Legal Business Name): SHAWN SWAIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2016
Last Update Date: 06/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 NW 29TH MNR
POMPANO BEACH FL
33069-1031
US

IV. Provider business mailing address

2500 NW 29TH MNR
POMPANO BEACH FL
33069-1031
US

V. Phone/Fax

Practice location:
  • Phone: 954-312-1700
  • Fax:
Mailing address:
  • Phone: 954-312-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License Number206199
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: