Provider Demographics
NPI:1073029013
Name:SHANU, DIXIE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:
Last Name:SHANU
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 NW 85TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-5182
Mailing Address - Country:US
Mailing Address - Phone:954-435-5867
Mailing Address - Fax:
Practice Address - Street 1:3725 NW 85TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-5182
Practice Address - Country:US
Practice Address - Phone:954-435-5867
Practice Address - Fax:954-435-5867
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-27
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9254490363LF0000X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatalGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily