Provider Information for 1194380006
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SHAWNETTE MILES MSW
Sex: Female
NPI: 1194380006
Last Updated: 2020-04-08
Certification Date: 2020-04-08
Certification Date: 2020-04-08
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1194380006 | ||||||||
| Enumeration Date | 2019-05-06 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 2355 W MICHIGAN AVE APT E10 PENSACOLA, FL 32526-2326 United States Phone: 850-361-8967 | Fax: | ||||||||
| Primary Practice Address | 112 W CERVANTES ST PENSACOLA, FL 32501-3128 United States Phone: 850-361-8967 | Fax: | ||||||||
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