Individual
SHANNON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
HOME HEATH AIDE
Contact information
Practice address
636 CANDYCE AVE, LAKELAND, FL 33815-1202
(863) 614-4071
Mailing address
636 CANDYCE AVE, SAME, LAKELAND, FL 33815-1202
(863) 614-4071
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
—
—
Other
Enumeration date
08/18/2015
Last updated
08/18/2015
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