Healthcare Provider Details

I. General information

NPI: 1760116248
Provider Name (Legal Business Name): ABIGAIL THORNDYKE SHONROCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 100165
GAINESVILLE FL
32610-0165
US

IV. Provider business mailing address

E 5TH STREET 104 RAWL BUILDING
GREENVILLE NC
27858-4353
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6617
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12895
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: