Provider Demographics
NPI:1194578534
Name:SURRELLE, SHAWNA JAYNE (MD)
Entity type:Individual
Prefix:DR
First Name:SHAWNA
Middle Name:JAYNE
Last Name:SURRELLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 BISCAYNE BLVD APT 804
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-3273
Mailing Address - Country:US
Mailing Address - Phone:305-773-0917
Mailing Address - Fax:
Practice Address - Street 1:4250 BISCAYNE BLVD APT 804
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-3273
Practice Address - Country:US
Practice Address - Phone:305-773-0917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00755622086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery