Healthcare Provider Details

I. General information

NPI: 1518829225
Provider Name (Legal Business Name): GLORIA SHAFAYE ANTWI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3513 KINGSTON ST N
SAINT PETERSBURG FL
33713-1324
US

IV. Provider business mailing address

3513 KINGSTON ST N
SAINT PETERSBURG FL
33713-1324
US

V. Phone/Fax

Practice location:
  • Phone: 727-815-2915
  • Fax:
Mailing address:
  • Phone: 727-815-2915
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number358905
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: