Individual
SHELLY A CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
744 W BRANDON BLVD, BRANDON, FL 33511-4902
(813) 390-4684
Mailing address
1019 MILANO CIR APT 108, BRANDON, FL 33511-7177
(813) 390-4684
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
—
—
Other
Enumeration date
07/19/2020
Last updated
07/19/2020
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