Healthcare Provider Details

I. General information

NPI: 1992502934
Provider Name (Legal Business Name): SHAUN ALLADIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 S KIRKMAN RD STE 730
ORLANDO FL
32819-7911
US

IV. Provider business mailing address

8211 SUN SPRING CIR UNIT 33
ORLANDO FL
32825-4714
US

V. Phone/Fax

Practice location:
  • Phone: 321-332-6984
  • Fax: 321-332-6984
Mailing address:
  • Phone: 954-536-9191
  • Fax: 954-536-9191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH23115
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: