Organization
SHENANDOAH MEDICAL CARE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS JOY L FULLER (ARNP)
(561) 853-7233
Entity
Organization
Contact information
Practice address
6313 LANSDOWNE CIR, BOYNTON BEACH, FL 33472-5108
(561) 853-7233
Mailing address
6313 LANSDOWNE CIR, BOYNTON BEACH, FL 33472-5108
(561) 853-7233
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
—
—
261QP2300X
Primary Care Clinic/Center
Primary
2602122
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720228208
NPI
FL
Enumeration date
04/04/2014
Last updated
04/04/2014
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