Provider Demographics
NPI:1407367303
Name:CARSWELL, SHANE MAURICE (APRN/PSYCH)
Entity type:Individual
Prefix:MR
First Name:SHANE
Middle Name:MAURICE
Last Name:CARSWELL
Suffix:
Gender:M
Credentials:APRN/PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 NW 150TH AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2888
Mailing Address - Country:US
Mailing Address - Phone:954-431-9838
Mailing Address - Fax:954-241-6726
Practice Address - Street 1:2010 NW 150TH AVE STE 120
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2888
Practice Address - Country:US
Practice Address - Phone:954-431-9838
Practice Address - Fax:954-241-6726
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9338546363LF0000X, 363LP0808X
SCAPRN21345363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily