Provider Demographics
NPI:1508371451
Name:RICHARDSON, SHENA-SHARISE
Entity Type:Individual
Prefix:
First Name:SHENA-SHARISE
Middle Name:
Last Name:RICHARDSON
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 1:16350 BRUCE B DOWNS AVE
Mailing Address - Street 2:47301
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-9001
Mailing Address - Country:US
Mailing Address - Phone:727-512-7271
Mailing Address - Fax:
Practice Address - Street 1:1249 BRUCE B DOWNS BLVD # 7
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-9261
Practice Address - Country:US
Practice Address - Phone:727-512-7271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-13
Last Update Date:2017-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist