Healthcare Provider Details

I. General information

NPI: 1891623906
Provider Name (Legal Business Name): SHAVAR PAUL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2026
Last Update Date: 05/11/2026
Certification Date: 05/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1763 LONNIE RD
TALLAHASSEE FL
32308-5649
US

IV. Provider business mailing address

1763 LONNIE RD
TALLAHASSEE FL
32308-5649
US

V. Phone/Fax

Practice location:
  • Phone: 850-597-6142
  • Fax:
Mailing address:
  • Phone: 850-597-6142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberL26000237667
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: