Provider Demographics
NPI:1003679598
Name:HILL, SHALONDA D
Entity Type:Individual
Prefix:
First Name:SHALONDA
Middle Name:D
Last Name:HILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 N FLORIDA AVE STE C3
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-1417
Mailing Address - Country:US
Mailing Address - Phone:800-975-1485
Mailing Address - Fax:
Practice Address - Street 1:9000 N FLORIDA AVE STE C3
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-1417
Practice Address - Country:US
Practice Address - Phone:800-975-1485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00-334-5259-229175T00000X
FL01241179224374U00000X
FL00241179224172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No175T00000XOther Service ProvidersPeer Specialist
No374U00000XNursing Service Related ProvidersHome Health Aide