Provider Demographics
NPI:1013246644
Name:HARRIS, RODERICK MASHUN (MSW)
Entity Type:Individual
Prefix:MR
First Name:RODERICK
Middle Name:MASHUN
Last Name:HARRIS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3061 ADIRON WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-7484
Mailing Address - Country:US
Mailing Address - Phone:850-339-8389
Mailing Address - Fax:
Practice Address - Street 1:3061 ADIRON WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32317-7484
Practice Address - Country:US
Practice Address - Phone:850-339-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-10
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist