Healthcare Provider Details

I. General information

NPI: 1639008048
Provider Name (Legal Business Name): JESICA ELIZABETH SHEARHOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N WYMORE RD
WINTER PARK FL
32789-2822
US

IV. Provider business mailing address

1030 LOCH VAIL UNIT 23
APOPKA FL
32712-2672
US

V. Phone/Fax

Practice location:
  • Phone: 321-295-4786
  • Fax:
Mailing address:
  • Phone: 321-295-4786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH29255
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: