Provider Demographics
NPI:1306873278
Name:SHAMASKIN, SUSAN MINDY (DO)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:MINDY
Last Name:SHAMASKIN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1447 MEDICAL PARK BLVD
Mailing Address - Street 2:#402
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414
Mailing Address - Country:US
Mailing Address - Phone:561-790-2600
Mailing Address - Fax:561-790-1535
Practice Address - Street 1:1447 MEDICAL PARK BLVD
Practice Address - Street 2:#402
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414
Practice Address - Country:US
Practice Address - Phone:561-790-2600
Practice Address - Fax:561-790-1535
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2011-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS0006066208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371457800Medicaid
FL371457800Medicaid