MEDICARE: SHA-LONDA GARY

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	IMH22575	FL

General Provider Information

NPI Number	:	1629832605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHA-LONDA GARY

Provider Business Mailing Address
First Line	:	PO BOX 748465
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-8465
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:

Provider Business Practice Location Address
First Line	:	4243 SUNBEAM RD STE 1
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-8975
Country	:	US
Telephone Number	:	855-284-7483
Fax Number	:

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

Provider Enumeration Date	:	02/09/2024
Last Update Date	:	06/15/2026

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Directions to “ SHA-LONDA GARY ” Practice Location

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