Healthcare Provider Details

I. General information

NPI: 1891964607
Provider Name (Legal Business Name): SHANOTTIA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7446 N TAMIAMI TRL
SARASOTA FL
34243-1807
US

IV. Provider business mailing address

7446 N TAMIAMI TRL
SARASOTA FL
34243-1807
US

V. Phone/Fax

Practice location:
  • Phone: 941-359-8777
  • Fax: 941-351-1901
Mailing address:
  • Phone: 941-359-8777
  • Fax: 941-351-1901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License NumberCH5478
License Number StateFL

VIII. Authorized Official

Name: DR. KIMBERLY ANN GARVIN
Title or Position: OWNER
Credential: DC
Phone: 941-359-8777