Provider Demographics
NPI:1659316867
Name:KRANENDONK, SHAUNA K (MD)
Entity type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:K
Last Name:KRANENDONK
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 1:224 CHIMNEY CORNER LN
Mailing Address - Street 2:SUITE # 3002
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-4800
Mailing Address - Country:US
Mailing Address - Phone:561-820-0155
Mailing Address - Fax:561-691-3281
Practice Address - Street 1:224 CHIMNEY CORNER LN
Practice Address - Street 2:SUITE # 3002
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-4800
Practice Address - Country:US
Practice Address - Phone:561-820-0155
Practice Address - Fax:561-691-3281
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-19
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84713207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL207NS0135ZOtherTAXONOMY NUMBER
FL207NS0135ZOtherTAXONOMY NUMBER
FLK0398Medicare ID - Type Unspecified