Provider Demographics
NPI:1215399837
Name:BARNES, SHANNON V (LICENSED COSMETOLOGI)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:V
Last Name:BARNES
Suffix:
Gender:F
Credentials:LICENSED COSMETOLOGI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 WATERFALL CIRCLE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-9227
Mailing Address - Country:US
Mailing Address - Phone:386-795-2042
Mailing Address - Fax:
Practice Address - Street 1:1205 SOUTH PARK AVENUE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-2853
Practice Address - Country:US
Practice Address - Phone:386-795-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2018-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCL1250034174400000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No174400000XOther Service ProvidersSpecialist