Individual
LORI SHAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1616 SEMINOLE RD, JACKSONVILLE, FL 32205-8635
(904) 485-0861
Mailing address
1616 SEMINOLE RD, JACKSONVILLE, FL 32205-8635
(904) 485-0861
Taxonomy
Speciality
Code
Description
License number
State
174N00000X
Lactation Consultant (Non-RN)
Primary
L-60764
FL
Other
Enumeration date
12/08/2014
Last updated
12/08/2014
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