Provider Demographics
NPI:1710900600
Name:SHAUNA KRANENDONK LLC
Entity Type:Organization
Organization Name:SHAUNA KRANENDONK LLC
Other - Org Name:SKYE CENTER FOR DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SHAUNA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KRANENDONK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-820-0155
Mailing Address - Street 1:224 CHIMNEY CORNER LANE
Mailing Address - Street 2:SUITE#3002
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458
Mailing Address - Country:US
Mailing Address - Phone:561-820-0155
Mailing Address - Fax:561-691-3281
Practice Address - Street 1:224 CHIMNEY CORNER LANE
Practice Address - Street 2:SUITE#3002
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458
Practice Address - Country:US
Practice Address - Phone:561-820-0155
Practice Address - Fax:561-691-3281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHAUNA KRANENDONK, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84713207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1659316867OtherINDIVIDUAL NPI
FLH16219Medicare UPIN
FL1659316867OtherINDIVIDUAL NPI