Provider Demographics
NPI:1881120632
Name:WEATHERS, SHAMONDY (BS)
Entity type:Individual
Prefix:
First Name:SHAMONDY
Middle Name:
Last Name:WEATHERS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 CLARK RD
Mailing Address - Street 2:STE 107
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-5596
Mailing Address - Country:US
Mailing Address - Phone:904-765-0665
Mailing Address - Fax:
Practice Address - Street 1:435 CLARK RD
Practice Address - Street 2:STE 107
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-5596
Practice Address - Country:US
Practice Address - Phone:904-765-0665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker