Provider Demographics
NPI:1538576301
Name:FRASER-DAMAS, SHONTE (MD, MBA, MHMS)
Entity type:Individual
Prefix:
First Name:SHONTE
Middle Name:
Last Name:FRASER-DAMAS
Suffix:
Gender:F
Credentials:MD, MBA, MHMS
Other - Prefix:
Other - First Name:SHONTE
Other - Middle Name:
Other - Last Name:FRASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:880 NW 13TH ST STE 4004TH
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-2342
Mailing Address - Country:US
Mailing Address - Phone:561-297-4814
Mailing Address - Fax:
Practice Address - Street 1:880 NW 13TH ST STE 4004TH
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2342
Practice Address - Country:US
Practice Address - Phone:516-297-4814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty