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Individual

TASHONDRA DANIELS WILEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
11537 CRICKET CT, JACKSONVILLE, FL 32218-3604
(904) 449-8125
(904) 570-9947
Mailing address
PO BOX 28189, JACKSONVILLE, FL 32226-8189
(904) 449-8125
(904) 570-9947

Taxonomy

Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary

Other

Enumeration date
04/19/2018
Last updated
04/19/2018
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