Individual
SHACOLA BRIDGES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4765 OSPREY WAY, WINTER HAVEN, FL 33881-9105
(954) 865-4809
Mailing address
4765 OSPREY WAY, WINTER HAVEN, FL 33881-9105
(954) 865-4809
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
01/13/2020
Last updated
01/13/2020
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