Individual
MR. FURTARDO SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
39 GRACE CUNNINGHAM RD, QUINCY, FL 32352-6757
(850) 728-6553
Mailing address
39 GRACE CUNNINGHAM RD, QUINCY, FL 32352-6757
(850) 728-6553
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
A306712
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
A306712
—
FL
Enumeration date
10/09/2016
Last updated
10/09/2016
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