MEDICARE: MRS. SHABANA MANDVIWALA CHURRUCA LMHC

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	MH8262	FL

General Provider Information

NPI Number	:	1407095235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHABANA MANDVIWALA CHURRUCA LMHC

Provider Business Mailing Address
First Line	:	3848 FLATIRON LOOP
Second Line	:	SUITE #101
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7825
Country	:	US
Telephone Number	:	813-777-3872
Fax Number	:	813-864-6731

Provider Business Practice Location Address
First Line	:	3848 FLATIRON LOOP
Second Line	:	SUITE #101
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7825
Country	:	US
Telephone Number	:	813-777-3872
Fax Number	:	813-864-6731

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

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	07/31/2013

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