Individual
SHAMANE THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9757 WATERSHED CT, JACKSONVILLE, FL 32220-0913
(904) 537-0812
Mailing address
9757 WATERSHED CT, JACKSONVILLE, FL 32220-0913
(904) 537-0812
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
FL
251C00000X
Developmentally Disabled Services Day Training Agency
—
—
Other
Enumeration date
07/19/2022
Last updated
07/19/2022
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