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General NPI Number Information
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NPI Number | 1245462928
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Entity Type | Individual
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Provider Name | SHANELL CODY
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Gender | Female
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Dates
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Enumeration Date | 08/14/2009
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 4130 COUNTRY CLUB RD S
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City | WINTER HAVEN
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State | FL
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Zip | 33881-8228
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Country | US
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Telephone | 863-210-4292
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Fax | 863-875-5348
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Provider Business Mailing Address
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Address Line | PO BOX 81
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City | WINTER HAVEN
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State | FL
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Zip | 33882-0081
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Country | US
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Telephone | 863-210-4292
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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 | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | CNA87627
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | 693195296
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 693195298
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License Number State | FL
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