Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT2161 | FL |
NPI | 1447735162 |
---|---|
Provider Name | Shandelyn Lewis Caraballo |
First Address | Lauderhill, FL 33313-2443 |
Second Address | Lauderhill, FL 33313-2443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2018 |
Last Update Date | 27/09/2018 |