Provider Demographics
NPI:1124474226
Name:FEDERMAN, SHAINA FRAIDA MUSHKA (CNM)
Entity type:Individual
Prefix:
First Name:SHAINA
Middle Name:FRAIDA MUSHKA
Last Name:FEDERMAN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:SHAINA
Other - Middle Name:
Other - Last Name:TORON-FEDERMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:8110 ROYAL PALM BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-5742
Mailing Address - Country:US
Mailing Address - Phone:954-341-8288
Mailing Address - Fax:954-341-5165
Practice Address - Street 1:8110 ROYAL PALM BLVD STE 108
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5742
Practice Address - Country:US
Practice Address - Phone:954-341-8288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9327852367A00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner