Provider Demographics
NPI:1629463401
Name:BOSS, SHAWNIECE DEVON (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHAWNIECE
Middle Name:DEVON
Last Name:BOSS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 COVE BEND DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2752
Mailing Address - Country:US
Mailing Address - Phone:813-972-4300
Mailing Address - Fax:813-972-4180
Practice Address - Street 1:3210 COVE BEND DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2752
Practice Address - Country:US
Practice Address - Phone:813-972-4300
Practice Address - Fax:813-972-4180
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO4090213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPO4090OtherSTATE LICENSE