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General NPI Number Information
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NPI Number | 1346758489
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Entity Type | Individual
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Provider Name | SHAMIYA A WALKER
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Gender | Female
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 02/02/2018
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Provider Practice Location Address
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Address Line | 5230 11TH AVE S
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City | GULFPORT
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State | FL
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Zip | 33707-3605
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Country | US
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Telephone | 727-452-7287
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Fax |
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Provider Business Mailing Address
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Address Line | 5230 11TH AVE S
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City | GULFPORT
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State | FL
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Zip | 33707-3605
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Country | US
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Telephone | 727-452-7287
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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 | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number | 82-1912427
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License Number State | FL
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