Provider Demographics
NPI:1679041891
Name:SEGALOFF, SHANNON REBECCA (APRN)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:REBECCA
Last Name:SEGALOFF
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6812 BRIDLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3591
Mailing Address - Country:US
Mailing Address - Phone:954-732-7858
Mailing Address - Fax:
Practice Address - Street 1:6080 BOYNTON BEACH BLVD STE 240
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3586
Practice Address - Country:US
Practice Address - Phone:561-509-5009
Practice Address - Fax:567-738-0556
Is Sole Proprietor?:No
Enumeration Date:2018-11-06
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN9278265208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics