Healthcare Provider Details

I. General information

NPI: 1366819146
Provider Name (Legal Business Name): NE'SHAUN JANAY BORDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2015
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3027 SAN DIEGO RD
JACKSONVILLE FL
32207-3691
US

IV. Provider business mailing address

3027 SAN DIEGO RD
JACKSONVILLE FL
32207-3691
US

V. Phone/Fax

Practice location:
  • Phone: 904-493-7744
  • Fax: 904-348-2818
Mailing address:
  • Phone: 904-493-7774
  • Fax: 904-348-2818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: