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General NPI Number Information
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NPI Number | 1558029454
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Entity Type | Organization
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Legal Business Name | UNBREAKABLE GODDESS BY SHAKEENA LLC
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Dates
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Enumeration Date | 12/08/2021
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 609 MINNESOTA DR
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City | CLEARWATER
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State | FL
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Zip | 33755-2540
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Country | US
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Telephone | 727-831-4746
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Fax |
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Provider Business Mailing Address
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Address Line | 1OO SOUTH BELCHER ROAD #7413
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City | CLEARWATER
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State | FL
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Zip | 33758
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Country | US
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Telephone | 727-831-4746
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHAKEENA JACKSON
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Credential |
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Telephone | 727-831-4746
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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