Provider Demographics
NPI:1780328823
Name:WATKINS, SHAWN NICOLE
Entity type:Individual
Prefix:MISS
First Name:SHAWN
Middle Name:NICOLE
Last Name:WATKINS
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 1:901 CROWSNEST CIR APT 107
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-3391
Mailing Address - Country:US
Mailing Address - Phone:407-697-8494
Mailing Address - Fax:
Practice Address - Street 1:901 CROWSNEST CIR APT 107
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-3391
Practice Address - Country:US
Practice Address - Phone:407-697-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL418587225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist