Provider Demographics
NPI:1336155217
Name:HAMPTON, SHAWNNA MINNETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:SHAWNNA
Middle Name:MINNETTE
Last Name:HAMPTON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 970154
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33497-0154
Mailing Address - Country:US
Mailing Address - Phone:561-289-9467
Mailing Address - Fax:561-826-8971
Practice Address - Street 1:2900 N MILITARY TRL
Practice Address - Street 2:STE 245
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6365
Practice Address - Country:US
Practice Address - Phone:561-289-9467
Practice Address - Fax:561-826-8971
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2013-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL276068100Medicaid
FLU8055XMedicare PIN