Individual
SHANNON BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
550 N REO ST, TAMPA, FL 33609-1061
(813) 374-2070
(813) 337-0937
Mailing address
2681 ROOSEVELT BLVD, APT 6107, CLEARWATER, FL 33760-2962
(305) 619-5739
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
05/07/2017
Last updated
05/07/2017
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