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General NPI Number Information
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NPI Number | 1154492262
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Entity Type | Individual
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Provider Name | NANCY C SHORES LMT
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Gender | Female
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Dates
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Enumeration Date | 11/11/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1894 S 14TH ST SUITE 3
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4494
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Country | US
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Telephone | 904-261-0622
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Fax |
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Provider Business Mailing Address
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Address Line | 1739 PHILIPS MANOR RD
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-5341
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Country | US
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Telephone | 904-415-5589
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Fax | 904-261-8875
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | MA00030617
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License Number State | FL
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