Individual
SHANELL CODY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4130 COUNTRY CLUB RD S, WINTER HAVEN, FL 33881-8228
(863) 210-4292
(863) 875-5348
Mailing address
PO BOX 81, WINTER HAVEN, FL 33882-0081
(863) 210-4292
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
693195296
FL
376K00000X
Nurse's Aide
Primary
693195298
FL
376K00000X
Nurse's Aide
CNA87627
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002344700
—
FL
05
—
693195296
—
FL
Enumeration date
08/14/2009
Last updated
06/29/2023
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