Provider Demographics
NPI:1750947008
Name:HALL, SHAWN LANGLEY
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:LANGLEY
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12904 RAIN FOREST ST
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1304
Mailing Address - Country:US
Mailing Address - Phone:813-956-7924
Mailing Address - Fax:
Practice Address - Street 1:14449 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-2000
Practice Address - Country:US
Practice Address - Phone:813-373-5443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-13
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies