Provider Demographics
NPI:1609762574
Name:ZHANG, SHULAN (LMT)
Entity type:Individual
Prefix:
First Name:SHULAN
Middle Name:
Last Name:ZHANG
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3979 MEADOWVIEW DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-1694
Mailing Address - Country:US
Mailing Address - Phone:904-755-5068
Mailing Address - Fax:
Practice Address - Street 1:804 ANASTASIA BLVD UNIT A
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-4618
Practice Address - Country:US
Practice Address - Phone:904-755-5068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-16
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL96570225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL96570OtherMASSAGE THERAPIST LICENSE