Provider Demographics
NPI:1134754534
Name:MASSARO, SHAWN YVONNE (APRN)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:YVONNE
Last Name:MASSARO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 TIMPANA PT
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3108
Mailing Address - Country:US
Mailing Address - Phone:516-404-2755
Mailing Address - Fax:
Practice Address - Street 1:3044 TIMPANA PT
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3108
Practice Address - Country:US
Practice Address - Phone:516-404-2755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11005340363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily