Healthcare Provider Details

I. General information

NPI: 1134038540
Provider Name (Legal Business Name): SHAUNNA MICHELLE RODRIGUEZ CCC, BCMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5551 SW 18TH TER # 494A
BUSHNELL FL
33513-4459
US

IV. Provider business mailing address

5551 SW 18TH TER # 494A
BUSHNELL FL
33513-4459
US

V. Phone/Fax

Practice location:
  • Phone: 352-207-6689
  • Fax:
Mailing address:
  • Phone: 352-207-6689
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: