Healthcare Provider Details

I. General information

NPI: 1407285497
Provider Name (Legal Business Name): SHANEICE URBINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2013
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 S ORANGE BLOSSOM TRL #264
ORLANDO FL
32805-3118
US

IV. Provider business mailing address

4401 THORNBRIAR LN
ORLANDO FL
32822-2271
US

V. Phone/Fax

Practice location:
  • Phone: 321-558-7044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: