| Doctor Name: | MS. SHANNON MACK |
| NPI Number: | 1194113936 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP |
| License Number: | ARNP9304496 |
| Business Practice Address: | 5000 W Oakland Park Blvd Lauderdale Lakes, FL - 333131503 |
| Business Phone Number: | 9547356000 |
| Business Fax Number: | |
| Mailing Address: | 8301 Nw 48th St, LAUDERHILL |
| State: | FL |
| Postal Code: | 333515543 |
| Phone Number: | 9548498424 |
| Fax Number: | |
| NPI Enumeration Date: | 01/01/2015 |
| NPI Last Update Date: | 01/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2100X |
| License Number: | ARNP9304496 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Acute Care |
| Taxonomy Definition: | |