MEDICARE: MRS. SHAWNDRA ERICA MAINE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	101Y00000X	Counselor
3	106H00000X	Marriage & Family Therapist
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1790942233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHAWNDRA ERICA MAINE

Provider Business Mailing Address
First Line	:	7264 W OAKLAND PARK BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-1041
Country	:	US
Telephone Number	:	954-703-1165
Fax Number	:	954-900-4645

Provider Business Practice Location Address
First Line	:	7264 W OAKLAND PARK BLVD
Second Line	:
City	:	LAUDERHILL
State	:	FL
Zip	:	33313-1041
Country	:	US
Telephone Number	:	954-703-1165
Fax Number	:	954-900-4645

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

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	05/14/2021

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