Healthcare Provider Details

I. General information

NPI: 1225905110
Provider Name (Legal Business Name): SHIRLEY RIBEIRO DE SOUZA MANETTA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2025
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1573 W FAIRBANKS AVE STE 100
WINTER PARK FL
32789-4679
US

IV. Provider business mailing address

1573 W FAIRBANKS AVE STE 100
WINTER PARK FL
32789-4679
US

V. Phone/Fax

Practice location:
  • Phone: 407-896-8097
  • Fax:
Mailing address:
  • Phone: 407-896-8097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11043176
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: