Healthcare Provider Details

I. General information

NPI: 1033736715
Provider Name (Legal Business Name): SHEENA BAKER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2020
Last Update Date: 10/08/2020
Certification Date: 10/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 MILLENNIUM PKWY STE 109
BRANDON FL
33511-3891
US

IV. Provider business mailing address

5019 CLOVER MIST DR
APOLLO BEACH FL
33572-3415
US

V. Phone/Fax

Practice location:
  • Phone: 405-808-4900
  • Fax:
Mailing address:
  • Phone: 405-808-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SHEENA BAKER
Title or Position: OWNER/CLINICIAN
Credential: LCSW
Phone: 405-808-4900