Provider Demographics
NPI:1386221976
Name:VUJINOVIC, SHANNON RENEE (CRDH, BASDH)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:RENEE
Last Name:VUJINOVIC
Suffix:
Gender:F
Credentials:CRDH, BASDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10881 STRADA LN APT 203
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5093
Mailing Address - Country:US
Mailing Address - Phone:727-656-0943
Mailing Address - Fax:
Practice Address - Street 1:12123 LITTLE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-2924
Practice Address - Country:US
Practice Address - Phone:727-379-9250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-28
Last Update Date:2021-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH24727124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist