Provider Demographics
NPI:1750983870
Name:MYERS, SHAUN A (PA)
Entity type:Individual
Prefix:
First Name:SHAUN
Middle Name:A
Last Name:MYERS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 CRYSTAL BEACH DR STE 137-C
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-3569
Mailing Address - Country:US
Mailing Address - Phone:850-226-7100
Mailing Address - Fax:
Practice Address - Street 1:137 CRYSTAL BEACH DR STE 137-C
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-3569
Practice Address - Country:US
Practice Address - Phone:850-226-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9113673363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant