Provider Demographics
NPI:1093361685
Name:DANIELS, SHADA A
Entity Type:Individual
Prefix:MS
First Name:SHADA
Middle Name:A
Last Name:DANIELS
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 1:9228 THUNDERBOLT DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-8052
Mailing Address - Country:US
Mailing Address - Phone:904-365-0105
Mailing Address - Fax:
Practice Address - Street 1:9228 THUNDERBOLT DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-8052
Practice Address - Country:US
Practice Address - Phone:904-365-0105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-10
Last Update Date:2019-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care