Individual
SHANNIA FULLERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
62 COLUMBIA ST, ORLANDO, FL 32806-1115
(321) 214-4903
(321) 843-2196
Mailing address
62 COLUMBIA ST, ORLANDO, FL 32806-1115
(321) 214-4903
(321) 843-2196
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
32697719
FL
367H00000X
Anesthesiologist Assistant
Primary
AA621
FL
Other
Enumeration date
08/26/2020
Last updated
12/29/2023
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