Provider Demographics
NPI:1740048248
Name:SCOTT, SHATONDRA (PHLEBOTOMIST)
Entity type:Individual
Prefix:
First Name:SHATONDRA
Middle Name:
Last Name:SCOTT
Suffix:
Gender:F
Credentials:PHLEBOTOMIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4223 TROON PL
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-1353
Mailing Address - Country:US
Mailing Address - Phone:754-215-6822
Mailing Address - Fax:
Practice Address - Street 1:850 S 21ST ST STE M
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4846
Practice Address - Country:US
Practice Address - Phone:800-356-6021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-08
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy