Provider Demographics
NPI:1366993651
Name:SHANVI INC
Entity type:Organization
Organization Name:SHANVI INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/(AO)
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DEMBOWSKE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-288-4911
Mailing Address - Street 1:2520 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4533
Mailing Address - Country:US
Mailing Address - Phone:772-288-4911
Mailing Address - Fax:772-288-0691
Practice Address - Street 1:2520 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4533
Practice Address - Country:US
Practice Address - Phone:772-288-4911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-20
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
FLME104784261QU0200X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty