Provider Demographics
NPI:1487191664
Name:MULLINGS, SHAUNA
Entity Type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:
Last Name:MULLINGS
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SHAUNA
Other - Middle Name:
Other - Last Name:HARVEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MBBS, FRCPC
Mailing Address - Street 1:1900 CENTRACARE CIRCLE #1300
Mailing Address - Street 2:CENTRACARE CLINIC PEDIATRIC/ADOLESCENT MEDICINE
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-5000
Mailing Address - Country:US
Mailing Address - Phone:320-654-3610
Mailing Address - Fax:320-564-3647
Practice Address - Street 1:1900 CENTRACARE CIRCLE #1300
Practice Address - Street 2:CENTRACARE CLINIC PEDIATRIC/ADOLESCENT MEDICINE
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-5000
Practice Address - Country:US
Practice Address - Phone:320-654-3610
Practice Address - Fax:320-564-3647
Is Sole Proprietor?:No
Enumeration Date:2017-01-25
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN61501208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics