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General NPI Number Information
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NPI Number | 1447618640
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Entity Type | Individual
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Provider Name | SHALONDRIA BOSTIC
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Gender | Female
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Dates
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Enumeration Date | 02/02/2016
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Last Update Date | 02/02/2016
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Provider Practice Location Address
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Address Line | 1575 52ND AVE N 3 YEARS
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City | ST PETERSBURG
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State | FL
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Zip | 33703-2629
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Country | US
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Telephone | 727-550-7257
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Fax |
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Provider Business Mailing Address
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Address Line | 1575 52ND AVE N 3 YEARS
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City | ST PETERSBURG
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State | FL
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Zip | 33703-2629
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Country | US
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Telephone | 727-550-7257
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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 | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6906812
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License Number State | FL
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