Provider Demographics
NPI:1427599323
Name:DILLARD, SHAWANZA
Entity Type:Individual
Prefix:
First Name:SHAWANZA
Middle Name:
Last Name:DILLARD
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 1:1843 PAGE LEIGH CIR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-3478
Mailing Address - Country:US
Mailing Address - Phone:407-272-7823
Mailing Address - Fax:
Practice Address - Street 1:1843 PAGE LEIGH CIR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-3478
Practice Address - Country:US
Practice Address - Phone:407-272-7823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician