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General NPI Number Information
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NPI Number | 1114290681
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Entity Type | Individual
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Provider Name | SHANDA MARIE CLARKE-FOLIKUMAH D.C.
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Gender | Female
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Dates
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Enumeration Date | 02/14/2012
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Last Update Date | 02/19/2013
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Provider Practice Location Address
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Address Line | 1838 CAPITAL CIR NE
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City | TALLAHASSEE
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State | FL
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Zip | 32308-4420
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Country | US
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Telephone | 850-402-9060
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Fax | 850-402-9063
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Provider Business Mailing Address
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Address Line | 1838 CAPITAL CIRCLE N.E.
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City | TALLAHASSEE
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State | FL
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Zip | 32308
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Country | US
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Telephone | 850-402-9060
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Fax | 850-402-9063
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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 | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH10283
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License Number State | FL
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