Individual
SHONDELL M BOUIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
110 LONGWOOD AVE, ROCKLEDGE, FL 32955-2828
(321) 636-2211
(321) 633-7085
Mailing address
PO BOX 1943, INDIANAPOLIS, IN 46206-1943
(877) 261-9061
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME104881
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001223400
—
FL
Enumeration date
05/02/2007
Last updated
06/20/2013
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