Provider Demographics
NPI:1659494813
Name:ALLEN, SHIRLEY ANN
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:ANN
Last Name:ALLEN
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 1:2155 15 ST SW
Mailing Address - Street 2:OSLO PARK
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32962
Mailing Address - Country:US
Mailing Address - Phone:772-766-4788
Mailing Address - Fax:
Practice Address - Street 1:2155 15 ST SW
Practice Address - Street 2:OSLO PARK
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32962
Practice Address - Country:US
Practice Address - Phone:772-766-4788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide