Provider Demographics
NPI:1407222193
Name:HUFFMAN, SHAWN
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:HUFFMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 ENTERPRISE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8256
Mailing Address - Country:US
Mailing Address - Phone:386-775-0220
Mailing Address - Fax:386-775-0221
Practice Address - Street 1:2751 ENTERPRISE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8256
Practice Address - Country:US
Practice Address - Phone:386-775-0220
Practice Address - Fax:386-775-0221
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS5115237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist