Provider Demographics
NPI:1679162846
Name:DROUILLARD, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:DROUILLARD
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 1:118 PATTERSON DR
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33823-2324
Mailing Address - Country:US
Mailing Address - Phone:863-258-6106
Mailing Address - Fax:
Practice Address - Street 1:1762 HAWTHORNE ST STE 5
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2100
Practice Address - Country:US
Practice Address - Phone:941-330-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker