Individual
SHADIA JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFA
Contact information
Practice address
2600 BRUCE B DOWNS BLVD, WESLEY CHAPEL, FL 33544-9207
(813) 952-4957
Mailing address
9333 SAINT LEGER PL, WESLEY CHAPEL, FL 33544-5474
(813) 952-4957
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
189828
FL
208600000X
Surgery Physician
189828
FL
246ZC0007X
Surgical Assistant
Primary
189828
FL
Other
Enumeration date
12/10/2024
Last updated
12/10/2024
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