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General NPI Number Information
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NPI Number | 1154217099
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Entity Type | Individual
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Provider Name | SHANON DEIDRE AGBEVE
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Gender | Female
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Dates
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Enumeration Date | 06/17/2025
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Last Update Date | 06/17/2025
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Provider Practice Location Address
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Address Line | 8900 N KENDALL DR
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City | MIAMI
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State | FL
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Zip | 33176-2197
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Country | US
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Telephone | 305-348-9414
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Fax |
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Provider Business Mailing Address
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Address Line | 13716 SW 143RD ST UNIT F
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City | MIAMI
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State | FL
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Zip | 33186-7563
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Country | US
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Telephone | 954-729-3191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 43367
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License Number State | FL
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