Healthcare Provider Details

I. General information

NPI: 1811619927
Provider Name (Legal Business Name): SHAINA URAL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 08/11/2025
Certification Date: 08/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4930 E LAKE MARY BLVD
SANFORD FL
32771-5003
US

IV. Provider business mailing address

4930 E LAKE MARY BLVD
SANFORD FL
32771-5003
US

V. Phone/Fax

Practice location:
  • Phone: 407-322-8645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1-185092
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN11037444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: