Provider Demographics
NPI:1356946230
Name:DUPREE, SHAWANNA ANNETTE
Entity type:Individual
Prefix:
First Name:SHAWANNA
Middle Name:ANNETTE
Last Name:DUPREE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAWANNA
Other - Middle Name:ANNETTE
Other - Last Name:BUSBY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:860 AVENIDA CENTRAL
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-7701
Mailing Address - Country:US
Mailing Address - Phone:352-750-1118
Mailing Address - Fax:352-753-8890
Practice Address - Street 1:860 AVENIDA CENTRAL
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-7701
Practice Address - Country:US
Practice Address - Phone:352-750-1118
Practice Address - Fax:352-753-8890
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist