Healthcare Provider Details

I. General information

NPI: 1194968099
Provider Name (Legal Business Name): SHAYNA BROOKE SEXTON M.ED, ED.S, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAYNA BROOKE DEMANGONE

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 BLUE HERON BLVD W
RIVIERA BEACH FL
33404-4006
US

IV. Provider business mailing address

278 VILLAGE BLVD UNIT 8205
TEQUESTA FL
33469-4006
US

V. Phone/Fax

Practice location:
  • Phone: 352-374-5600
  • Fax:
Mailing address:
  • Phone: 561-322-5081
  • 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: