Provider Demographics
NPI:1629030655
Name:MCKINNEY, TRENITY SHANE (MD)
Entity Type:Individual
Prefix:
First Name:TRENITY
Middle Name:SHANE
Last Name:MCKINNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1868 TAMIAMI TRL S
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-3160
Mailing Address - Country:US
Mailing Address - Phone:941-493-9393
Mailing Address - Fax:941-492-6650
Practice Address - Street 1:1868 TAMIAMI TRL S
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-3160
Practice Address - Country:US
Practice Address - Phone:941-493-9393
Practice Address - Fax:941-492-6650
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93436207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME93436OtherSTATE LISENCE
FLME93436OtherSTATE LISENCE
FL29579ZMedicare ID - Type UnspecifiedMEDICARE NUMBER