Provider Demographics
NPI:1760668974
Name:LEAKES, SHAVONDA B (PHARMD, CPH, CSP)
Entity Type:Individual
Prefix:DR
First Name:SHAVONDA
Middle Name:B
Last Name:LEAKES
Suffix:
Gender:F
Credentials:PHARMD, CPH, CSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N ORLANDO AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2914
Mailing Address - Country:US
Mailing Address - Phone:407-644-2830
Mailing Address - Fax:407-644-4843
Practice Address - Street 1:2416 LAKE ORANGE DR STE 190
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7814
Practice Address - Country:US
Practice Address - Phone:844-540-1644
Practice Address - Fax:844-489-9565
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34257183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist