Provider Demographics
NPI:1114654373
Name:WRAY, SHANIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SHANIE
Middle Name:
Last Name:WRAY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1234 SASSY WAY
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4421
Mailing Address - Country:US
Mailing Address - Phone:904-428-4656
Mailing Address - Fax:
Practice Address - Street 1:300 S CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4246
Practice Address - Country:US
Practice Address - Phone:407-900-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020970207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine