Provider Demographics
NPI:1316713811
Name:SHAMAMBO, ISABELLA MUKANDA
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:MUKANDA
Last Name:SHAMAMBO
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 1:11929 CORINNE LEE CT APT 102
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-2969
Mailing Address - Country:US
Mailing Address - Phone:239-322-9164
Mailing Address - Fax:239-931-9772
Practice Address - Street 1:11929 CORINNE LEE CT APT 102
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-2969
Practice Address - Country:US
Practice Address - Phone:239-322-9164
Practice Address - Fax:239-931-9772
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9569602163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse