Healthcare Provider Details

I. General information

NPI: 1326883901
Provider Name (Legal Business Name): ALYCIA SHAHEED
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2024
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 NW 107TH AVE STE 109
SWEETWATER FL
33172-2739
US

IV. Provider business mailing address

26150 SW 137TH AVE APT 104
NARANJA FL
33032-6986
US

V. Phone/Fax

Practice location:
  • Phone: 786-762-2952
  • Fax:
Mailing address:
  • Phone: 954-990-9819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: