Provider Demographics
NPI:1710566591
Name:MOSKO, SHANE
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:MOSKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 NW 72ND AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1348
Mailing Address - Country:US
Mailing Address - Phone:954-871-6690
Mailing Address - Fax:
Practice Address - Street 1:2550 NW 72ND AVE STE 305
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1348
Practice Address - Country:US
Practice Address - Phone:954-871-6690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies