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Individual

MS. SHENEKE GLENN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
564 MASON DR, HAVANA, FL 32333-5365
(757) 897-2562
Mailing address
564 MASON DR, HAVANA, FL 32333-5365
(757) 897-2562

Taxonomy

Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
85-2960957
FL
Enumeration date
12/07/2020
Last updated
12/07/2020
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