Provider Demographics
NPI:1659873891
Name:SHULL, DAYNA SUE (LAT, ATC)
Entity Type:Individual
Prefix:
First Name:DAYNA
Middle Name:SUE
Last Name:SHULL
Suffix:
Gender:F
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6331 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4124
Mailing Address - Country:US
Mailing Address - Phone:954-604-1209
Mailing Address - Fax:
Practice Address - Street 1:5050 AVE MARIA BLVD
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142
Practice Address - Country:US
Practice Address - Phone:239-304-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-04
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer