Provider Demographics
NPI:1275108078
Name:ETIENNE, SHANLAY
Entity Type:Individual
Prefix:MISS
First Name:SHANLAY
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:641 UNIVERSITY BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-2794
Mailing Address - Country:US
Mailing Address - Phone:561-253-8121
Mailing Address - Fax:561-253-8021
Practice Address - Street 1:COASTAL NEPHROLOGY & HYPERTENSION CENTER, P.A.
Practice Address - Street 2:641 UNIVERSITY BLVD SUITE 211
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-253-8121
Practice Address - Fax:561-253-8021
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily