Provider Demographics
NPI:1609272590
Name:JONES, SHAVONDA (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHAVONDA
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:413 FERN GULLEY DR
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-3740
Mailing Address - Country:US
Mailing Address - Phone:813-523-2658
Mailing Address - Fax:
Practice Address - Street 1:413 FERN GULLEY DR
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-3740
Practice Address - Country:US
Practice Address - Phone:813-523-2658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12697235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist