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Individual
SHANTELL S WRAY
Active
Individual
SHANTELL S WRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
002435
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1071883
NCCPA
—
05
—
115500100
—
FL
Enumeration date
10/15/2006
Last updated
10/03/2022
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