Healthcare Provider Details

I. General information

NPI: 1063171999
Provider Name (Legal Business Name): SHANA SUZANNE DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8849 HAWBUCK ST STE B
TRINITY FL
34655-9805
US

IV. Provider business mailing address

8849 HAWBUCK ST STE B
TRINITY FL
34655-9805
US

V. Phone/Fax

Practice location:
  • Phone: 727-358-9911
  • Fax:
Mailing address:
  • Phone: 727-358-9911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH18240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: