Provider Demographics
NPI:1033801725
Name:SALISBURY, SHONDA N (RCSWI 17989)
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:N
Last Name:SALISBURY
Suffix:
Gender:F
Credentials:RCSWI 17989
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8230 DAMES POINT CROSSING BLVD N UNIT 1005
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-3823
Mailing Address - Country:US
Mailing Address - Phone:904-962-5226
Mailing Address - Fax:
Practice Address - Street 1:8230 DAMES POINT CROSSING BLVD N UNIT 1005
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-3823
Practice Address - Country:US
Practice Address - Phone:904-962-5226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17989104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker