Provider Demographics
NPI:1417609652
Name:HALL, SHANDRIA
Entity Type:Individual
Prefix:
First Name:SHANDRIA
Middle Name:
Last Name:HALL
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 1:2918 S SEMORAN BLVD APT 8
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32822-2781
Mailing Address - Country:US
Mailing Address - Phone:321-246-4342
Mailing Address - Fax:
Practice Address - Street 1:2918 S SEMORAN BLVD APT 8
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-2781
Practice Address - Country:US
Practice Address - Phone:321-246-4342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator