Healthcare Provider Details

I. General information

NPI: 1811808504
Provider Name (Legal Business Name): SHAKAYLA MAULTSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 BROADWAY AVE
JACKSONVILLE FL
32254-3248
US

IV. Provider business mailing address

2566 BROADWAY AVE
JACKSONVILLE FL
32254-3248
US

V. Phone/Fax

Practice location:
  • Phone: 904-603-2570
  • Fax:
Mailing address:
  • Phone: 904-603-2570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number472836
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: