Provider Demographics
NPI:1437313426
Name:HEARING, SHAWN (LMT)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:HEARING
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:885 E PRIMA VISTA BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-2342
Mailing Address - Country:US
Mailing Address - Phone:772-340-0799
Mailing Address - Fax:772-340-4401
Practice Address - Street 1:885 E PRIMA VISTA BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-2342
Practice Address - Country:US
Practice Address - Phone:772-340-0799
Practice Address - Fax:772-340-4401
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA22392174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist