Provider Demographics
NPI:1548605967
Name:BERRY, SHAUNA E (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:E
Last Name:BERRY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9776 BONITA BEACH RD SE STE 202B
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4775
Mailing Address - Country:US
Mailing Address - Phone:239-308-0063
Mailing Address - Fax:239-495-4377
Practice Address - Street 1:9776 BONITA BEACH RD SE STE 202B
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4775
Practice Address - Country:US
Practice Address - Phone:239-308-0063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS16160207WX0109X, 207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmologyGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103371300Medicaid