Provider Demographics
NPI:1598530347
Name:MOUNT, SHANDRELL SHAMONE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:SHANDRELL
Middle Name:SHAMONE
Last Name:MOUNT
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5823 SUNLIGHT RD
Mailing Address - Street 2:
Mailing Address - City:MALONE
Mailing Address - State:FL
Mailing Address - Zip Code:32445-3211
Mailing Address - Country:US
Mailing Address - Phone:850-317-6632
Mailing Address - Fax:
Practice Address - Street 1:5823 SUNLIGHT RD
Practice Address - Street 2:
Practice Address - City:MALONE
Practice Address - State:FL
Practice Address - Zip Code:32445-3211
Practice Address - Country:US
Practice Address - Phone:850-317-6632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11029802363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily