Healthcare Provider Details

I. General information

NPI: 1750034187
Provider Name (Legal Business Name): SHANA MORREALE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2022
Last Update Date: 02/12/2026
Certification Date: 02/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15416 N FLORIDA AVE
TAMPA FL
33613-1210
US

IV. Provider business mailing address

4197 WOODLANDS PKWY
PALM HARBOR FL
34685-3493
US

V. Phone/Fax

Practice location:
  • Phone: 813-960-2400
  • Fax: 813-960-2410
Mailing address:
  • Phone: 813-333-1512
  • Fax: 813-333-1561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115480
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: