Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0203X | Pediatric Critical Care Doctor | ME144400 | FL |
NPI | 1104246545 |
---|---|
Provider Name | Shannon Renee Faulkinberry |
First Address | Orlando, FL 32806-2032 |
Second Address | Orlando, FL 32806-2032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2014 |
Last Update Date | 11/08/2020 |