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General NPI Number Information
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NPI Number | 1518774454
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Entity Type | Individual
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Provider Name | SHEA MACKENZIE MALONE-BOYD WHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 427 E CENTRAL AVE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3051
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Country | US
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Telephone | 863-299-1107
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Fax |
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Provider Business Mailing Address
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Address Line | 703 CENTER ST
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City | DUNDEE
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State | FL
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Zip | 33838-4039
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Country | US
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Telephone | 850-628-4084
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN11036710
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License Number State | FL
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