Provider Demographics
NPI:1841947041
Name:WATSON, SHALAAH
Entity type:Individual
Prefix:MRS
First Name:SHALAAH
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAYA
Other - Middle Name:
Other - Last Name:NATURELLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4416 GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-5451
Mailing Address - Country:US
Mailing Address - Phone:727-753-8841
Mailing Address - Fax:
Practice Address - Street 1:4416 GRAND BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-5451
Practice Address - Country:US
Practice Address - Phone:727-753-8841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-07
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management