Individual
MS. SHANIN LEAH DEGRAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1885 S 14TH ST, FERNANDINA BEACH, FL 32034-3033
(904) 277-4449
Mailing address
27307 CONNER RD, HILLIARD, FL 32046
(904) 237-9391
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PTA22943
FL
Other
Enumeration date
05/02/2012
Last updated
05/02/2012
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