Healthcare Provider Details

I. General information

NPI: 1104117837
Provider Name (Legal Business Name): SHIVANA GENTRY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2011
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2827 CHAPELWOOD CT
OVIEDO FL
32765-8441
US

IV. Provider business mailing address

2827 CHAPELWOOD CT
OVIEDO FL
32765-8441
US

V. Phone/Fax

Practice location:
  • Phone: 954-729-7649
  • Fax:
Mailing address:
  • Phone: 954-729-7649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH11983
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: