Provider Demographics
NPI:1699833103
Name:SHINTRE, LATA (MD)
Entity Type:Individual
Prefix:
First Name:LATA
Middle Name:
Last Name:SHINTRE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 W. CAMINO REAL, SUITE 102
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-235-5206
Mailing Address - Fax:561-235-5210
Practice Address - Street 1:7600 W. CAMINO REAL, SUITE 102
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-235-5206
Practice Address - Fax:561-235-5210
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98055207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2703864Medicaid
FL279924300Medicaid
FLAM234VOtherMEDICARE, PTAN
OH2703864Medicaid
FL279924300Medicaid