Individual
SHANTELL WALKINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1407 GRAND CLUB BLVD, FORT PIERCE, FL 34982-8134
(772) 249-6749
Mailing address
1407 GRAND CLUB BLVD, FORT PIERCE, FL 34982-8134
(772) 249-6749
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025014000
—
FL
Enumeration date
12/20/2018
Last updated
12/20/2018
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