Provider Demographics
NPI:1891758132
Name:BENNETT, SHAUGHN C (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAUGHN
Middle Name:C
Last Name:BENNETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560604
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33256-0604
Mailing Address - Country:US
Mailing Address - Phone:305-270-3236
Mailing Address - Fax:305-270-3237
Practice Address - Street 1:9240 SUNSET DR
Practice Address - Street 2:SUITE 229
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3261
Practice Address - Country:US
Practice Address - Phone:305-270-3236
Practice Address - Fax:305-270-3237
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5245207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80019OtherBCBS
FL224516OtherAVMED
FL411396OtherAETNA
FL000343OtherNEIGHBORHOOD HEALTH PARTN
FL1686622002OtherCIGNA
FL170254OtherHUMANA
FL411396OtherAETNA
FL170254OtherHUMANA