Individual
RASHEDA JUANDRELL TYSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2702 MASSACHUSETTS AVE APT 185, PENSACOLA, FL 32505-3475
(850) 382-7803
Mailing address
2702 MASSACHUSETTS AVE APT 185, PENSACOLA, FL 32505-3475
(850) 382-7803
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
CL1275593
FL
224P00000X
Prosthetist
Primary
CL1275593
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0827
NONE
—
Enumeration date
05/14/2020
Last updated
05/14/2020
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