Individual
MS. ELIZABETH INEZ SHIDEMANTLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BS MS CAC
Contact information
Practice address
1600 SARNO RD STE 3, MELBOURNE, FL 32935-4992
(321) 622-6290
Mailing address
105 W SEMINOLE AVE APT 1, MELBOURNE, FL 32901-2933
(321) 339-8560
Taxonomy
Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary
—
—
Other
Enumeration date
02/01/2021
Last updated
02/01/2021
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