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General NPI Number Information
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NPI Number | 1538646963
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Entity Type | Individual
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Provider Name | SHANNON M COUILLARD CLC
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Gender | Female
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Dates
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Enumeration Date | 07/27/2018
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Last Update Date | 07/27/2018
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Provider Practice Location Address
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Address Line | 4397 WYNDCLIFF CIR
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City | ORLANDO
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State | FL
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Zip | 32817-3310
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Country | US
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Telephone | 407-243-8571
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Fax |
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Provider Business Mailing Address
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Address Line | 10151 UNIVERSITY BLVD # 241
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City | ORLANDO
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State | FL
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Zip | 32817-1904
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Country | US
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Telephone | 407-243-8571
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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 | 174N00000X
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Taxonomy Name | Lactation Consultant (Non-RN)
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License Number | 259524
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License Number State | DE
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