Healthcare Provider Details

I. General information

NPI: 1235846544
Provider Name (Legal Business Name): SHINA REI-ANN DODDS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2022
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11624 YUMA LN N
OSSEO MN
55369-7505
US

IV. Provider business mailing address

11624 YUMA LN N
OSSEO MN
55369-7505
US

V. Phone/Fax

Practice location:
  • Phone: 786-222-4784
  • Fax:
Mailing address:
  • Phone: 786-222-4784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number11015791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: