Healthcare Provider Details

I. General information

NPI: 1215812151
Provider Name (Legal Business Name): SARAH BETH SHIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12550 SW 75TH AVE
PINECREST FL
33156-6063
US

IV. Provider business mailing address

12550 SW 75TH AVE
PINECREST FL
33156-6063
US

V. Phone/Fax

Practice location:
  • Phone: 786-344-9307
  • Fax:
Mailing address:
  • Phone: 786-344-9307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: