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General NPI Number Information
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NPI Number | 1750624250
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Entity Type | Organization
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Legal Business Name | ANGELSONYOURSHOULDER
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Dates
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Enumeration Date | 04/03/2013
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Last Update Date | 04/03/2013
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Provider Practice Location Address
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Address Line | 487 GODFREY RD SE
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City | PALM BAY
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State | FL
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Zip | 32909-8861
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Country | US
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Telephone | 321-914-0755
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Fax | 321-327-8571
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Provider Business Mailing Address
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Address Line | 487 GODFREY RD SE
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City | PALM BAY
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State | FL
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Zip | 32909-8861
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Country | US
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Telephone | 321-914-0755
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Fax | 321-327-8571
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Authorized Official
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Title or Position | OWNER
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Name | YOLLY M SCHAROUN
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Credential |
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Telephone | 321-501-9056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12257
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License Number State | FL
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