Individual
SHANON T GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1044 LAKESIDE DR, APOPKA, FL 32712-8115
(077) 660-0884
Mailing address
1044 LAKESIDE DR, APOPKA, FL 32712-8115
(407) 766-0884
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106038000
—
FL
Enumeration date
01/31/2020
Last updated
09/27/2020
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