| Provider / Organization | NPI | Date Certified |
|---|---|---|
| SHANON T GIBSON | 1962033670 | 2020-09-27 |
Shanon T Gibson is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1962033670. Registration indicates Shanon T Gibson is a provider of services with a specialization in Agencies, Early Intervention Provider Agency (Early Intervention Provider Agency, ) (Early Intervention Provider Agency, Agencies)
| Entity Type | Individual |
| Provider Name | Shanon T Gibson |
| Practice Office Address | 1044 LAKESIDE DR APOPKA, FL US |
| Practice Office Telephone | 0776600884 |
| Mailing Address | 1044 LAKESIDE DR APOPKA, FL 327128115 US |
| Business Telephone | 4077660884 |
| Code | Practice | License No State |
|---|---|---|
| 252Y00000X PRIMARY | Agencies Early Intervention Provider Agency Early Intervention Provider Agency Early Intervention Provider Agency Agencies |
| 106038000 | MEDICAID | FL |