Provider Demographics
NPI:1104861939
Name:MARINEAU, SHIRLEY ALICE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ALICE
Last Name:MARINEAU
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2336 IMMOKALEE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1414
Mailing Address - Country:US
Mailing Address - Phone:239-591-8481
Mailing Address - Fax:239-596-0212
Practice Address - Street 1:2336 IMMOKALEE RD
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1414
Practice Address - Country:US
Practice Address - Phone:239-591-8481
Practice Address - Fax:239-596-0212
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2011-08-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME480232080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL47177100Medicaid
FLD51095Medicare UPIN