Healthcare Provider Details

I. General information

NPI: 1588503536
Provider Name (Legal Business Name): MICHAEL SHANE HUEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 NARVAREZ AVE
SAINT AUGUSTINE FL
32084-9019
US

IV. Provider business mailing address

251 NARVAREZ AVE
SAINT AUGUSTINE FL
32084-9019
US

V. Phone/Fax

Practice location:
  • Phone: 954-560-5245
  • Fax:
Mailing address:
  • Phone: 954-560-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9349046
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: