Individual
SHANTAVIS SHANTRELL FAYSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2802 NE 53RD CT # 194, GAINESVILLE, FL 32609-2625
(850) 933-1399
Mailing address
2802 NE 53RD CT # 194, GAINESVILLE, FL 32609-2625
(850) 933-1399
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
5242314
FL
Other
Enumeration date
01/10/2022
Last updated
01/10/2022
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