Provider Demographics
NPI:1295173375
Name:GREGOIRE, SHAUN-PIERRE A (MD)
Entity type:Individual
Prefix:DR
First Name:SHAUN-PIERRE
Middle Name:A
Last Name:GREGOIRE
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 1:1505 KNOX MCRAE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780
Mailing Address - Country:US
Mailing Address - Phone:321-222-9070
Mailing Address - Fax:321-821-1899
Practice Address - Street 1:1505 KNOX MCRAE DRIVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780
Practice Address - Country:US
Practice Address - Phone:321-222-9070
Practice Address - Fax:321-821-1899
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN 19211207Q00000X
FLME126507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine