Wallace-Jackson, Shenikwa

Wallace-Jackson, Shenikwa is an individual health care provider with primary practice located at 177 Daffodil Dr Sw # D102 , Palm Bay FL 32908-3329. She recently has 2 registered licenses in different health care specialties including Nursing Service Related Providers / Homemaker, Nursing Service Related Providers / Home Health Aide. Nursing Service Related Providers / Home Health Aide is her primary health care specialty. Wallace-Jackson, Shenikwa can be contacted via phone (321) 223-2659.

Contact Information

Primary practice address
177 Daffodil Dr Sw # D102 Palm Bay FL 32908-3329
Phone: (321) 223-2659
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Related Providers / Homemaker 376J00000X Florida
Nursing Service Related Providers / Home Health Aide 374U00000X Florida

Profile Details

NPI number 1598287187
LBN Legal business name Wallace-Jackson, Shenikwa
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 14th, 2017
Last updated Jul 21st, 2022 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598287187 NPPES
Florida MEDICAID 822161617

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