Provider Demographics
NPI:1578393856
Name:RANCE, SHAKEEDRA NICHELLE
Entity type:Individual
Prefix:
First Name:SHAKEEDRA
Middle Name:NICHELLE
Last Name:RANCE
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 1:351 CASCADE BEND DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-6309
Mailing Address - Country:US
Mailing Address - Phone:727-239-8413
Mailing Address - Fax:
Practice Address - Street 1:351 CASCADE BEND DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-6309
Practice Address - Country:US
Practice Address - Phone:727-239-8413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-02
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health