Individual
SHENIKWA WALLACE-JACKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
177 DAFFODIL DR SW # D102, PALM BAY, FL 32908-3329
(321) 223-2659
Mailing address
177 DAFFODIL DR SW # D102, PALM BAY, FL 32908-3329
(321) 223-2659
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
FL
376J00000X
Homemaker
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
822161617
—
FL
Enumeration date
07/14/2017
Last updated
07/21/2022
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