Provider Demographics
NPI:1588676175
Name:LOHSE, SHAREEN (PA-C)
Entity Type:Individual
Prefix:
First Name:SHAREEN
Middle Name:
Last Name:LOHSE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SHAREEN
Other - Middle Name:
Other - Last Name:DEBLASIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 AVENTURA BLVD
Mailing Address - Street 2:S. 205
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-3124
Mailing Address - Country:US
Mailing Address - Phone:305-933-6716
Mailing Address - Fax:
Practice Address - Street 1:2925 AVENTURA BLVD
Practice Address - Street 2:S. 205
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-3124
Practice Address - Country:US
Practice Address - Phone:305-933-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9101490363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP33822Medicare UPIN
FLE56822Medicare ID - Type Unspecified