Individual
DOMINIQUE SHELTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
419 W 49TH ST, HIALEAH, FL 33012-3654
(855) 832-6727
Mailing address
1860 NW 112TH TER, MIAMI, FL 33167-3539
(786) 908-5003
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
024055700
—
FL
Enumeration date
03/03/2018
Last updated
08/29/2020
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