Individual
MRS. SHIRLEY STOVALL OTUSANYA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1100 NE 213TH TER, MIAMI, FL 33179-1314
(305) 652-0973
Mailing address
1100 NE 213TH TER, MIAMI, FL 33179-1314
(305) 652-0973
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
230408200
—
FL
Enumeration date
05/27/2008
Last updated
05/27/2008
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