Provider Demographics
NPI:1376011155
Name:JEKABSONS, SHAUNA LEANN
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:LEANN
Last Name:JEKABSONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:325 SHERWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-3037
Mailing Address - Country:US
Mailing Address - Phone:615-613-1100
Mailing Address - Fax:
Practice Address - Street 1:325 SHERWOOD AVE
Practice Address - Street 2:
Practice Address - City:SATELLITE BCH
Practice Address - State:FL
Practice Address - Zip Code:32937-3037
Practice Address - Country:US
Practice Address - Phone:615-613-1100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-09
Last Update Date:2018-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator