MEDICARE: SHAWN LATRICE HAIR

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	253Z00000X	In Home Supportive Care Agency	87-0835223	FL

General Provider Information

NPI Number	:	1811671282
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWN LATRICE HAIR

Provider Business Mailing Address
First Line	:	3241 OLD WINTER GARDEN RD STE 26
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-1124
Country	:	US
Telephone Number	:	321-594-3829
Fax Number	:

Provider Business Practice Location Address
First Line	:	3960 W.D. JUDGE .DR.APT138
Second Line	:	3960 W D JUDGE DR.APT138
City	:	ORLANDO
State	:	FL
Zip	:	32808
Country	:	US
Telephone Number	:	132-159-4382
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	06/14/2023

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Directions to “ SHAWN LATRICE HAIR ” Practice Location

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