MEDICARE: MR. SHAWN LANGLEY HALL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1750947008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHAWN LANGLEY HALL

Provider Business Mailing Address
First Line	:	12904 RAIN FOREST ST
Second Line	:
City	:	TEMPLE TERRACE
State	:	FL
Zip	:	33617-1304
Country	:	US
Telephone Number	:	813-956-7924
Fax Number	:

Provider Business Practice Location Address
First Line	:	14449 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2000
Country	:	US
Telephone Number	:	813-373-5443
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2019
Last Update Date	:	05/13/2019

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