MEDICARE: SHAVON CALIN NATHAN

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	RBT-26-536863	FL

General Provider Information

NPI Number	:	1528997707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAVON CALIN NATHAN

Provider Business Mailing Address
First Line	:	3260 STOCKTON ST APT 315
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33903-1622
Country	:	US
Telephone Number	:	754-272-1669
Fax Number	:

Provider Business Practice Location Address
First Line	:	1432 GRAHAM CIR
Second Line	:
City	:	LEHIGH ACRES
State	:	FL
Zip	:	33936-1110
Country	:	US
Telephone Number	:	305-390-2369
Fax Number	:

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

Provider Enumeration Date	:	05/14/2026
Last Update Date	:	05/14/2026

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