MEDICARE: SHAWNDOLYN BRUTEN

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	363L00000X	Nurse Practitioner	APRN11008739	FL
2	363LF0000X	Family Nurse Practitioner	APRN11008739	FL

General Provider Information

NPI Number	:	1629685060
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNDOLYN BRUTEN

Provider Business Mailing Address
First Line	:	PO BOX 3731
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32721-3731
Country	:	US
Telephone Number	:	386-868-6180
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 S SEGRAVE ST
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-4815
Country	:	US
Telephone Number	:	386-868-6180
Fax Number	:

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

Provider Enumeration Date	:	09/29/2020
Last Update Date	:	09/29/2020

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Directions to “ SHAWNDOLYN BRUTEN ” Practice Location

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