MEDICARE: CAREA SHAVONNE GUNN B.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1689918062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAREA SHAVONNE GUNN B.A

Provider Business Mailing Address
First Line	:	1609 BANNING BEACH RD
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-2024
Country	:	US
Telephone Number	:	407-692-8940
Fax Number	:

Provider Business Practice Location Address
First Line	:	1609 BANNING BEACH RD
Second Line	:
City	:	TAVARES
State	:	FL
Zip	:	32778-2024
Country	:	US
Telephone Number	:	407-692-8940
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2012
Last Update Date	:	11/25/2012

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