Healthcare Provider Details

I. General information

NPI: 1790038396
Provider Name (Legal Business Name): MRS. SHIRLEY AUDREY JOSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2012
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7324 WILLOW SPGS CIR N.
BOYNTON BEACH FL
33436
US

IV. Provider business mailing address

7324 WILLOW SPGS CIR N
BOYNTON BEACH FL
33436
US

V. Phone/Fax

Practice location:
  • Phone: 561-649-6227
  • Fax: 561-649-6227
Mailing address:
  • Phone: 561-649-6227
  • Fax: 561-649-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number#6905710
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number6905710
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: