Provider Demographics
NPI:1356932610
Name:ISRAEL, SHAVONNA JEWDEYAH
Entity type:Individual
Prefix:
First Name:SHAVONNA
Middle Name:JEWDEYAH
Last Name:ISRAEL
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 1:5549 FORT CAROLINE RD # 123
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-1748
Mailing Address - Country:US
Mailing Address - Phone:904-252-0661
Mailing Address - Fax:
Practice Address - Street 1:2232 MISSION CREEK CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-8818
Practice Address - Country:US
Practice Address - Phone:904-252-0661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula