Individual
SHANQUITA MOORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9602 SEAVIEW DR APT 101, LEESBURG, FL 34788-7699
(850) 960-3277
Mailing address
9602 SEAVIEW DR APT 101, LEESBURG, FL 34788-7699
(850) 960-3277
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
FL
Enumeration date
07/27/2020
Last updated
07/29/2020
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