Shawn James Douglas, DDS, MHA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN 17419 Issued in FL

Practice address

1821 Wellness LN BLDG 3
Trinity, FL 34655-5359

Phone

(727) 372-3200

Fax

(727) 372-0505

NPI assigned

May 10, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Douglas Dentistry P a

  • Durable Medical Equipment & Medical Supplies
  • Trinity, FL
  • NPI 1801358395
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1554163200000",
    "number": "1790990299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 WELLNESS LN BLDG 3",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346555359",
            "telephone_number": "727-372-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 WELLNESS LN BLDG 3",
            "city": "TRINITY",
            "state": "FL",
            "postal_code": "346555359",
            "telephone_number": "727-372-3200",
            "fax_number": "727-372-0505"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8734 N Mobley Rd",
            "address_purpose": "LOCATION",
            "city": "Odessa",
            "state": "FL",
            "postal_code": "335562509",
            "country_code": "US",
            "telephone_number": "813-920-2326",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "SHAWN",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DDS, MHA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-10",
        "last_updated": "2019-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN 17419",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donna L Donati-Waddell, PSY.D.
• James Patrick Donovan, M.D.
• Cameron Dornon, P.T.A.
• Gerard Dorta Torres
• Douglas Dentistry P a
• Sheilah M Drevon, M.D.
• Michale Drew, APRN
• Justin Lee Drobisch, AA
• Kimberley Kay Drury, ARNP
• Zachary Jorge Duarte, MD

• General Practice Dentistry in Trinity, FL
• Providers in Trinity, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.