Organization
SHENANDOAH MEDICAL CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JOY L FULLER ARNP (OWNER)
(561) 853-7233
Entity
Organization
Contact information
Practice address
6234 S CONGRESS AVE, SUITE F-1, LANTANA, FL 33462-2307
(561) 619-9510
Mailing address
PO BOX 741424, BOYNTON BEACH, FL 33474-1424
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
2602122
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010866400
—
FL
Enumeration date
01/19/2017
Last updated
01/19/2017
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