Provider Demographics
NPI:1649306010
Name:HARRIS DONALDSON, SHANDRA RENAE (CNA HHA MEDICAID WAI)
Entity type:Individual
Prefix:MRS
First Name:SHANDRA
Middle Name:RENAE
Last Name:HARRIS DONALDSON
Suffix:
Gender:F
Credentials:CNA HHA MEDICAID WAI
Other - Prefix:
Other - First Name:SHANDRA
Other - Middle Name:RENAE
Other - Last Name:TURNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1689 TILLEY AVE
Mailing Address - Street 2:APT A
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756
Mailing Address - Country:US
Mailing Address - Phone:727-518-6242
Mailing Address - Fax:727-559-8216
Practice Address - Street 1:1689 TILLEY AVE
Practice Address - Street 2:APT A
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756
Practice Address - Country:US
Practice Address - Phone:727-518-6242
Practice Address - Fax:727-559-8216
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL117003376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide