Healthcare Provider Details

I. General information

NPI: 1598530347
Provider Name (Legal Business Name): SHANDRELL SHAMONE MOUNT MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2023
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5823 SUNLIGHT RD
MALONE FL
32445-3211
US

IV. Provider business mailing address

5823 SUNLIGHT RD
MALONE FL
32445-3211
US

V. Phone/Fax

Practice location:
  • Phone: 850-317-6632
  • Fax:
Mailing address:
  • Phone: 850-317-6632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11029802
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: