Provider Demographics
NPI:1154902013
Name:AMAYA, SHAWN ANTHONY (CRT)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:ANTHONY
Last Name:AMAYA
Suffix:
Gender:M
Credentials:CRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40140 SWIFT RD
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-9560
Mailing Address - Country:US
Mailing Address - Phone:954-338-0230
Mailing Address - Fax:
Practice Address - Street 1:2250 BEDFORD RD # ROD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1443
Practice Address - Country:US
Practice Address - Phone:407-303-7869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTT14750227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified