Provider Demographics
NPI:1679396238
Name:FLOYD, SHAWNTE
Entity type:Individual
Prefix:
First Name:SHAWNTE
Middle Name:
Last Name:FLOYD
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 1:140 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-4418
Mailing Address - Country:US
Mailing Address - Phone:317-200-4667
Mailing Address - Fax:317-419-3131
Practice Address - Street 1:140 E 14TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-4418
Practice Address - Country:US
Practice Address - Phone:317-200-4667
Practice Address - Fax:317-419-3131
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27081216A164W00000X
IN24-016473-13747A0650X, 3747P1801X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty