Provider Demographics
NPI:1184417040
Name:STEPHENSON, SHAMICA
Entity type:Individual
Prefix:MRS
First Name:SHAMICA
Middle Name:
Last Name:STEPHENSON
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 1:1480 JUNIPER HAMMOCK ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2213
Mailing Address - Country:US
Mailing Address - Phone:407-466-1637
Mailing Address - Fax:
Practice Address - Street 1:1480 JUNIPER HAMMOCK ST
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2213
Practice Address - Country:US
Practice Address - Phone:407-466-1637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-23
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171245531251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health