Provider Demographics
NPI:1134695224
Name:GRAYSON, SHEENA L (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHEENA
Middle Name:L
Last Name:GRAYSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9305 SANDYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-7245
Mailing Address - Country:US
Mailing Address - Phone:305-814-4702
Mailing Address - Fax:
Practice Address - Street 1:4942 W STATE RD 46
Practice Address - Street 2:SUITE 1014
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771
Practice Address - Country:US
Practice Address - Phone:407-915-7307
Practice Address - Fax:407-915-7398
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57495183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist