Healthcare Provider Details

I. General information

NPI: 1497053698
Provider Name (Legal Business Name): SHUSHANNE SHERVANNESIA WYNTER-MINOTT ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 S STATE ROAD 7 STE 315
WELLINGTON FL
33414-6137
US

IV. Provider business mailing address

19977 KING FISHER LN
LOXAHATCHEE FL
33470-2539
US

V. Phone/Fax

Practice location:
  • Phone: 561-990-8878
  • Fax:
Mailing address:
  • Phone: 305-562-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9212318
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN9212318
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: