Individual
SHAUNTE FULCHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2804 PRICE AVE, FORT MYERS, FL 33916-4214
(404) 844-1123
Mailing address
1512 VERONICA S SHOEMAKER BLVD, FORT MYERS, FL 33916-2150
(404) 844-1123
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
F426794809080
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000000
N/A
FL
Enumeration date
03/04/2020
Last updated
03/04/2020
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