Healthcare Provider Details

I. General information

NPI: 1770298770
Provider Name (Legal Business Name): MRS. SHATOURIA MCCLELLAN WRIGHT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHATOURIA K MCCLELLAN

II. Dates (important events)

Enumeration Date: 01/16/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4987 NW LASSIE BLACK ST
WHITE SPRINGS FL
32096-7515
US

IV. Provider business mailing address

PO BOX 3394
LAKE CITY FL
32056-3394
US

V. Phone/Fax

Practice location:
  • Phone: 386-365-0319
  • Fax:
Mailing address:
  • Phone: 386-292-2958
  • Fax: 386-406-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW24911
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: