Provider Demographics
NPI:1114673035
Name:WALKER, SHALONDA (ADMINISTARTOR)
Entity Type:Individual
Prefix:MS
First Name:SHALONDA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:ADMINISTARTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 RIVERPLACE BLVD STE 105-1073
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-9046
Mailing Address - Country:US
Mailing Address - Phone:904-477-5009
Mailing Address - Fax:800-882-5037
Practice Address - Street 1:1200 RIVERPLACE BLVD STE 105-1073
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-9046
Practice Address - Country:US
Practice Address - Phone:904-477-5009
Practice Address - Fax:800-882-5037
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-01
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL377554374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide