Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CL1250034 | FL |
NPI | 1215399837 |
---|---|
Provider Name | Ms. Shannon V Barnes |
First Address | Deltona, FL 32725-9227 |
Second Address | Sanford, FL 32771-2853 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2016 |
Last Update Date | 23/02/2018 |