Provider Demographics
NPI:1184106155
Name:DANIEL, DEVON SHULOCK
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:SHULOCK
Last Name:DANIEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6816 SOUTHPOINT PKWY STE 500
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1702
Mailing Address - Country:US
Mailing Address - Phone:904-379-6250
Mailing Address - Fax:
Practice Address - Street 1:6816 SOUTHPOINT PKWY STE 500
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1702
Practice Address - Country:US
Practice Address - Phone:904-379-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-05
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician