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NPI Code Detail

MEDICARE: MUNCHKINS PEDIATRICS, LLC.

MEDICARE: MUNCHKINS PEDIATRICS, LLC.
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
1363LF0000XFamily Nurse Practitioner
2363LP0200XPediatric Nurse Practitioner
3363LP2300XPrimary Care Nurse Practitioner
4261QP2300XPrimary Care Clinic/Center
5208000000XPediatrics Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558821850
Entity Type Code : Organization
Provider Name (Legal Business Name) : MUNCHKINS PEDIATRICS, LLC.
Provider Business Mailing Address
First Line : 20718 HIGHPOND LN
Second Line :
City : DADE CITY
State : FL
Zip : 33523-6555
Country : US
Telephone Number : 813-892-5501
Fax Number : 352-437-3120
Provider Business Practice Location Address
First Line : 13540 17TH ST
Second Line :
City : DADE CITY
State : FL
Zip : 33525-5244
Country : US
Telephone Number : 352-437-3107
Fax Number : 352-437-3120
Authorized Official
Title or Position : OWNER/PROVIDER
Name : MS. SHAUNA MICHELE DESCHAMPS
Credential : APRN
Telephone Number : 352-437-3107
Provider Enumeration Date : 03/22/2019
Last Update Date : 11/21/2024

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Directions to “MUNCHKINS PEDIATRICS, LLC. ” Practice Location

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