Provider Demographics
NPI:1598306805
Name:WELCOME, DAUDRA SHAMON SR
Entity Type:Individual
Prefix:
First Name:DAUDRA
Middle Name:SHAMON
Last Name:WELCOME
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 BAHIA PASS PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34472-8290
Mailing Address - Country:US
Mailing Address - Phone:352-362-7839
Mailing Address - Fax:
Practice Address - Street 1:8 BAHIA PASS PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-8290
Practice Address - Country:US
Practice Address - Phone:352-362-7839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW425177654510172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver