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Individual

SAMANTHA LATOYA SHAW

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
357 SW LOG DR, PORT ST LUCIE, FL 34953-7501
(772) 274-3320
Mailing address
357 SW LOG DR, PORT ST LUCIE, FL 34953-7501
(772) 274-3320

Taxonomy

Speciality
Code
Description
License number
State
332U00000X
Home Delivered Meals
Primary
238034
FL
332U00000X
Home Delivered Meals

Other

Enumeration date
10/02/2024
Last updated
10/02/2024
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