Individual
SHAKALA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3430 CARUSO PL, OVIEDO, FL 32765-9020
(813) 407-9832
Mailing address
3430 CARUSO PL, OVIEDO, FL 32765-9020
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
P362794955820
FL
Other
Enumeration date
01/21/2017
Last updated
01/21/2017
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