Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | OS5268 | FL |
NPI | 1003036278 |
---|---|
Provider Name | Shellie Graham-Lapp |
First Address | Lake Mary, FL 32746-3315 |
Second Address | Lake Mary, FL 32746-3315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2007 |
Last Update Date | 30/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F30887 | (02) | FL |