Provider Demographics
NPI:1497053698
Name:WYNTER-MINOTT, SHUSHANNE SHERVANNESIA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:SHUSHANNE
Middle Name:SHERVANNESIA
Last Name:WYNTER-MINOTT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17444 SW 47TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5056
Mailing Address - Country:US
Mailing Address - Phone:305-562-1136
Mailing Address - Fax:
Practice Address - Street 1:601 N. FLAMINGO ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33065
Practice Address - Country:US
Practice Address - Phone:954-435-5828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9212318363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily