Healthcare Provider Details

I. General information

NPI: 1487191664
Provider Name (Legal Business Name): MRS. SHAUNA MULLINGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAUNA HARVEY MBBS, FRCPC

II. Dates (important events)

Enumeration Date: 01/25/2017
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 CENTRACARE CIRCLE #1300 CENTRACARE CLINIC PEDIATRIC/ADOLESCENT MEDICINE
SAINT CLOUD MN
56303-5000
US

IV. Provider business mailing address

1900 CENTRACARE CIRCLE #1300 CENTRACARE CLINIC PEDIATRIC/ADOLESCENT MEDICINE
SAINT CLOUD MN
56303-5000
US

V. Phone/Fax

Practice location:
  • Phone: 320-654-3610
  • Fax: 320-564-3647
Mailing address:
  • Phone: 320-654-3610
  • Fax: 320-564-3647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number61501
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: