Provider Demographics
NPI:1316992514
Name:AGUILERA, SHINO BAY (DO)
Entity type:Individual
Prefix:
First Name:SHINO
Middle Name:BAY
Last Name:AGUILERA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:HUMBERTO
Other - Middle Name:
Other - Last Name:AGUILERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 LAS OLAS BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301
Mailing Address - Country:US
Mailing Address - Phone:954-765-3005
Mailing Address - Fax:954-765-3007
Practice Address - Street 1:350 E LAS OLAS BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33301-4214
Practice Address - Country:US
Practice Address - Phone:954-765-3005
Practice Address - Fax:954-765-3007
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8398207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU5667YMedicare ID - Type Unspecified
FLU5667XMedicare ID - Type Unspecified
FLU5667WMedicare ID - Type Unspecified
FLU5667VMedicare ID - Type Unspecified
FLI39682Medicare UPIN
FLU5667UMedicare ID - Type Unspecified