Provider Demographics
NPI:1306070354
Name:SHEAR EXPRESSIONS
Entity type:Organization
Organization Name:SHEAR EXPRESSIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:ALICE
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-486-6899
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:BRONSON
Mailing Address - State:FL
Mailing Address - Zip Code:32621-0247
Mailing Address - Country:US
Mailing Address - Phone:352-486-6899
Mailing Address - Fax:352-486-3865
Practice Address - Street 1:490 E HATHAWAY AVE
Practice Address - Street 2:
Practice Address - City:BRONSON
Practice Address - State:FL
Practice Address - Zip Code:32621-6736
Practice Address - Country:US
Practice Address - Phone:352-486-6899
Practice Address - Fax:352-486-3865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMM20690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty