Individual
SHANE STICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
175 WRENN ST, TAVERNIER, FL 33070-2335
(305) 809-5000
(305) 809-5010
Mailing address
175 WRENN ST, TAVERNIER, FL 33070-2335
(305) 809-5000
(305) 809-5010
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
02/06/2012
Last updated
02/06/2012
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