Basic Information
| Provider Information | |||||||||
| NPI: | 1154902013 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMAYA | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | CRT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40140 SWIFT RD | ||||||||
| Address2: | |||||||||
| City: | EUSTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327369560 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543380230 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2250 BEDFORD RD # ROD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328031443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073037869 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2021 | ||||||||
| LastUpdateDate: | 04/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 227800000X | TT14750 | FL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Respiratory Therapist, Certified |
No ID Information.