Healthcare Provider Details

I. General information

NPI: 1760386189
Provider Name (Legal Business Name): SHANJIA WELLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12880 301 HWY
DADE CITY FL
33525
US

IV. Provider business mailing address

12880 US 301
DADE CITY FL
33525-5801
US

V. Phone/Fax

Practice location:
  • Phone: 352-437-3559
  • Fax: 352-608-9017
Mailing address:
  • Phone: 352-437-3559
  • Fax: 352-608-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: