Provider Demographics
NPI:1407283930
Name:MAYO-ANDREWS, SHAUNE (PHARM D)
Entity Type:Individual
Prefix:
First Name:SHAUNE
Middle Name:
Last Name:MAYO-ANDREWS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13919 SUMMER BREEZE DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-8456
Mailing Address - Country:US
Mailing Address - Phone:904-765-5161
Mailing Address - Fax:904-374-6661
Practice Address - Street 1:13919 SUMMER BREEZE DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8456
Practice Address - Country:US
Practice Address - Phone:904-765-5161
Practice Address - Fax:904-374-6661
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08011974OtherBITH DATE