Individual
CARLYSSA SHINELLE BUCKNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1801 WELLS RD STE 306, ORANGE PARK, FL 32073-2324
(904) 351-8530
Mailing address
1801 WELLS RD STE 306, ORANGE PARK, FL 32073-2324
(754) 273-2883
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA63694
FL
Other
Enumeration date
04/08/2024
Last updated
04/08/2024
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