Healthcare Provider Details

I. General information

NPI: 1285774000
Provider Name (Legal Business Name): SHANTE' CAMILLE HILL ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 TECHNOLOGICAL AVENUE SUITE 1
ORLANDO FL
32817-1476
US

IV. Provider business mailing address

7812 RICHWOOD DRIVE
ORLANDO FL
32825
US

V. Phone/Fax

Practice location:
  • Phone: 407-681-2520
  • Fax: 407-681-2521
Mailing address:
  • Phone: 407-539-4964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL # 1250
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: