Healthcare Provider Details

I. General information

NPI: 1841466950
Provider Name (Legal Business Name): SHAWN MASON PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11580 OAKHURST RD ST. A-1
LARGO FL
33774
US

IV. Provider business mailing address

11580 OAKHURST RD ST. A-1
LARGO FL
33774
US

V. Phone/Fax

Practice location:
  • Phone: 727-248-2438
  • Fax: 410-550-8161
Mailing address:
  • Phone: 727-248-2438
  • Fax: 410-550-8161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number04693
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY12451
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: