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General NPI Number Information
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NPI Number | 1104132760
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Entity Type | Individual
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Provider Name | SHASTA MICHELLE BYRD CNA
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Gender | Female
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Dates
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Enumeration Date | 08/20/2010
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Last Update Date | 08/20/2010
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Provider Practice Location Address
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Address Line | 91 SURF DR
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City | WINTER HAVEN
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State | FL
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Zip | 33880-5756
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Country | US
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Telephone | 863-325-8424
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Fax |
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Provider Business Mailing Address
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Address Line | 2726 OLD EAGLE LAKE WINTER HAVEN RD LOT 4
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City | EAGLE LAKE
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State | FL
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Zip | 33839-5402
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Country | US
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Telephone | 863-595-6865
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 156966
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License Number State | FL
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