Provider Demographics
NPI:1699754481
Name:FLANAGAN, SHAWNA (MD)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:FLANAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:600 HERITAGE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3000
Mailing Address - Country:US
Mailing Address - Phone:561-296-5222
Mailing Address - Fax:561-296-5221
Practice Address - Street 1:600 HERITAGE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3000
Practice Address - Country:US
Practice Address - Phone:561-296-5222
Practice Address - Fax:561-296-5221
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0070174207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL29006XMedicare Oscar/Certification