Provider Demographics
NPI:1326217548
Name:FULLER, SHIRLEY ANN
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:ANN
Last Name:FULLER
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 1:911 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-2540
Mailing Address - Country:US
Mailing Address - Phone:321-945-2893
Mailing Address - Fax:
Practice Address - Street 1:911 S PARK AVE
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-2540
Practice Address - Country:US
Practice Address - Phone:321-945-2893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist