Individual
MRS. LUCILLE SHAMA NANKISSORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2941 DANA LN, KISSIMMEE, FL 34744-5016
(407) 201-4095
Mailing address
2941 DANA LN, KISSIMMEE, FL 34744-5016
(407) 201-4095
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL12570
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
AL12570
—
FL
Enumeration date
10/21/2014
Last updated
10/21/2014
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