Individual
SHIRLEY TEMPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1505 SPITZ CT, BRANDON, FL 33511-4816
(813) 952-6865
(888) 870-9630
Mailing address
1505 SPITZ CT, BRANDON, FL 33511-4816
(813) 952-6865
(888) 870-9630
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
—
FL
Other
Enumeration date
10/14/2019
Last updated
10/14/2019
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