Individual
SHANTAR ORNELLA NICHOLAS I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6412 N UNIVERSITY DR STE 117, TAMARAC, FL 33321-4002
(954) 991-9359
Mailing address
5770 NW 60TH AVE APT E103, TAMARAC, FL 33319-2446
(954) 901-9359
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
11/15/2024
Last updated
11/15/2024
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