Healthcare Provider Details

I. General information

NPI: 1083015655
Provider Name (Legal Business Name): SHYNEA ANTHONY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12642 ADVENTURE DR
RIVERVIEW FL
33579-7790
US

IV. Provider business mailing address

9727 TRANQUILITY LAKE CIR APT 107
RIVERVIEW FL
33578-4011
US

V. Phone/Fax

Practice location:
  • Phone: 863-272-0279
  • Fax:
Mailing address:
  • Phone: 863-272-0279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: