MEDICARE: SHANTEL HANNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	ISW18584	FL

General Provider Information

NPI Number	:	1013611136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANTEL HANNA

Provider Business Mailing Address
First Line	:	450 CANDLESTICK AVE NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-2470
Country	:	US
Telephone Number	:	321-361-0810
Fax Number	:

Provider Business Practice Location Address
First Line	:	1227 S PATRICK DR STE 108
Second Line	:
City	:	SATELLITE BEACH
State	:	FL
Zip	:	32937-3969
Country	:	US
Telephone Number	:	321-773-1111
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2023
Last Update Date	:	07/01/2024

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Directions to “ SHANTEL HANNA ” Practice Location

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