Provider Demographics
NPI:1104486844
Name:CANTWELL, SHAYNE HYSON (APRN)
Entity type:Individual
Prefix:
First Name:SHAYNE
Middle Name:HYSON
Last Name:CANTWELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2830 CASA ALOMA WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2272
Mailing Address - Country:US
Mailing Address - Phone:321-397-0692
Mailing Address - Fax:
Practice Address - Street 1:2830 CASA ALOMA WAY
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-2272
Practice Address - Country:US
Practice Address - Phone:321-397-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily