Provider Demographics
NPI:1447148655
Name:ROUNDTREE, SHAVELLORY LATRICE
Entity type:Individual
Prefix:
First Name:SHAVELLORY
Middle Name:LATRICE
Last Name:ROUNDTREE
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 1:11064 APPLE BLOSSOM TRL W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-7362
Mailing Address - Country:US
Mailing Address - Phone:419-450-7217
Mailing Address - Fax:
Practice Address - Street 1:2316 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43613-4429
Practice Address - Country:US
Practice Address - Phone:419-450-7217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator