MEDICARE: MR. SHANE MAURICE CARSWELL APRN/PSYCH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN9338546	FL
2	363LF0000X	Family Nurse Practitioner	APRN21345	SC
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN9338546	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407367303
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHANE MAURICE CARSWELL APRN/PSYCH

Provider Business Mailing Address
First Line	:	2010 NW 150TH AVE STE 120
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2888
Country	:	US
Telephone Number	:	954-431-9838
Fax Number	:	954-241-6726

Provider Business Practice Location Address
First Line	:	2010 NW 150TH AVE STE 120
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33028-2888
Country	:	US
Telephone Number	:	954-431-9838
Fax Number	:	954-241-6726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2017
Last Update Date	:	12/06/2021

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