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Individual

MRS. SHAWNA NICOLE WALLACE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
M.A.

Contact information

Practice address
773 S KIRKMAN RD STE 119, ORLANDO, FL 32811-2046
(407) 496-2192
(407) 440-4510
Mailing address
1371 WINGED FOOT DR, APOPKA, FL 32712-2386
(407) 335-1704

Taxonomy

Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary

Other

Enumeration date
09/12/2020
Last updated
05/28/2021
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