Individual
SHANIECE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9521 FONTAINEBLEAU BLVD APT 118, MIAMI, FL 33172-6803
(201) 606-5745
Mailing address
9521 FONTAINEBLEAU BLVD APT 118, MIAMI, FL 33172-6803
(201) 606-5745
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/16/2016
Last updated
07/16/2016
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