Provider Demographics
NPI:1598552499
Name:YALONG, SHANIA XENA HUSOL
Entity type:Individual
Prefix:
First Name:SHANIA XENA
Middle Name:HUSOL
Last Name:YALONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 STILLWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-8024
Mailing Address - Country:US
Mailing Address - Phone:927-646-9271
Mailing Address - Fax:
Practice Address - Street 1:2050 STILLWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-8024
Practice Address - Country:US
Practice Address - Phone:927-646-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053866225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist