Healthcare Provider Details

I. General information

NPI: 1003281320
Provider Name (Legal Business Name): SHRONDA ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2015
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6519 NW 25TH TER
GAINESVILLE FL
32653-1581
US

IV. Provider business mailing address

PO BOX 141202
GAINESVILLE FL
32614-1202
US

V. Phone/Fax

Practice location:
  • Phone: 352-256-8182
  • Fax:
Mailing address:
  • Phone: 352-256-8182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number233993
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number233993
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: