Healthcare Provider Details

I. General information

NPI: 1508371451
Provider Name (Legal Business Name): SHENA-SHARISE RICHARDSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2017
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1249 BRUCE B DOWNS BLVD # 7
WESLEY CHAPEL FL
33544-9261
US

IV. Provider business mailing address

16350 BRUCE B DOWNS AVE 47301
TAMPA FL
33646-9001
US

V. Phone/Fax

Practice location:
  • Phone: 727-512-7271
  • Fax:
Mailing address:
  • Phone: 727-512-7271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: