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General NPI Number Information
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NPI Number | 1760668974
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Entity Type | Individual
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Provider Name | SHAVONDA B LEAKES PHARMD, CPH, CSP
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Gender | Female
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Dates
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Enumeration Date | 01/17/2008
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 2416 LAKE ORANGE DR STE 190
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City | ORLANDO
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State | FL
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Zip | 32837-7814
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Country | US
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Telephone | 844-540-1644
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Fax | 844-489-9565
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Provider Business Mailing Address
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Address Line | 440 N ORLANDO AVE
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City | WINTER PARK
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State | FL
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Zip | 32789-2914
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Country | US
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Telephone | 407-644-2830
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Fax | 407-644-4843
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS34257
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License Number State | FL
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